Longitudinal extensive transverse myelitis with cervical epidural haematoma following dengue virus infection

Abstract Background Longitudinal extensive transverse myelitis associated with dengue infection is rare with no reported paediatric cases. Methods We report a 12-year-old girl who presented with flaccid quadriplegia 8 days after onset of acute dengue fever. MRI spine showed T2 hyperintensity associa...

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Bibliographic Details
Published in:European journal of paediatric neurology 2016-05, Vol.20 (3), p.449-453
Main Authors: Fong, Choong Yi, Hlaing, Chaw Su, Tay, Chee Geap, Abdul Kadir, Khairul Azmi, Goh, Khean Jin, Ong, Lai Choo
Format: Article
Language:English
Subjects:
Child
Demyelination
Dengue
Dengue - complications
Dengue - diagnosis
Dengue - therapy
Dengue Virus
Female
Hematoma, Epidural, Spinal - diagnosis
Hematoma, Epidural, Spinal - therapy
Hematoma, Epidural, Spinal - virology
Humans
Magnetic Resonance Imaging
Myelitis, Transverse - diagnosis
Myelitis, Transverse - therapy
Myelitis, Transverse - virology
Neurology
Paediatric
Pediatrics
Quadriplegia - virology
Spinal cord
Transverse myelitis
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Summary:Abstract Background Longitudinal extensive transverse myelitis associated with dengue infection is rare with no reported paediatric cases. Methods We report a 12-year-old girl who presented with flaccid quadriplegia 8 days after onset of acute dengue fever. MRI spine showed T2 hyperintensity associated with epidural hematoma at C3–C6 level of the spinal cord. Transcranial magnetic brain stimulation revealed absent motor evoked potentials bilaterally. We also summarise and compare the reported cases of transverse myelitis associated with dengue infection. Results Immunomodulatory treatment was given which included pulse methylprednisolone, intravenous immunoglobulin and plasmapharesis. Six months post-admission, there was a good (near-complete) clinical recovery with the repeat MRI showing mild residual hyperintensity at C4 level and complete resolution of epidural haematoma. Conclusion This is the first reported paediatric case of longitudinal extensive transverse myelitis following dengue infection. It is also the first to illustrate that in patients with concomitant epidural haematoma a good outcome is possible despite not having surgical decompression. Clinicians should be aware of parainfectious dengue-related longitudinal extensive transverse myelitis in children and consider prompt immunomodulatory treatment.
ISSN:1090-3798
1532-2130
DOI:10.1016/j.ejpn.2016.01.012