Acute Disseminated Encephalomyelitis After Chikungunya Infection

Abstract

A 16-year-old girl presented with progressive diffuse pain in the lower limbs associated with paresis and unstable gait. She reported a 20dayhistoryofhighfever,rash,andseverearthralgiaonherhands,wrists, and knees. On presentation, neurologic examination showed severe quadriparesis presenting full-range movement of the upper and lower limbs only with gravity eliminated, without any changes in reflexes or sensitivity. The patient did not show any signs of vision impairment.Analysis of the spinal fluid revealed increased cellularity (white blood cell count of 91/μL [to convert to ×10 9 per liter], being 85% lymphocytes, 7% monocytes, 4% neutrophils, and 4% eosinophils; no red blood cells were found), protein level of 435 g/dL (to convert to grams per liter, multiply by 10), glucose level of 44 mg/dL (to convert to micromoles per liter, multiply by 0.0555), and normal cultures for both bacteria and fungi. Magnetic resonance imaging showed focal T2 and fluid-attenuated inversion recovery hyperintense lesion in corpus callosum, subcortical white matter, and medulla without restriction to diffusion. Spine magnetic resonance imaging showed extensive T2hyperintense area, predominantly posterior from C1 to C7 and central in the thoracic spine (Figure 1 and Figure 2).

The global burden of Chikungunya fever among children: A systematic literature review and meta-analysis

“…Other laboratory findings also reported included: neutrophilia, leukopenia, lymphopenia, hypokalemia, hyponatremia, hypocalcemia, hyperbilirubinemia, anaemia, elevated C-reactive protein, transaminases (aspartate, alanine and oxaloacetic glutamic), elevated cellularity and neutrophil predominance, elevated creatinine kinase, reduced prothrombin concentration (Fig 5). Cerebrospinal fluid (CSF) examination was reported in nine studies [68,71,73,[96][97][98][99][100], and showed pleocytosis (n=7 studies), increased protein levels (n=7 studies) and hypoglycorrhachia (n=3 studies). Radiological, CT and MRI scans presented abnormal findings indicating diffuse brain lesions, cerebral edema, soft tissue resorption and haemorrhagic leukoencephalopathy.…”

Effect of Viral Strain and Host Age on Clinical Disease and Viral Replication in Immunocompetent Mouse Models of Chikungunya Encephalomyelitis

“…However, up to 16.3% of patients also exhibit neurologic symptoms, which can persist for weeks to months after initial infection [ 3 ]. These can include encephalitis, myalgia, arthralgia, Horner syndrome, and Guillain–Barre syndrome [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. The neurologic outcomes for children < 1 year old is particularly severe, with around 50% of infants with CHIKV developing symptoms and neurologic delays [ 12 ].…”