Acute Dengue Encephalopathy in children: Time to look beyond JE

Background: Dengue encephalopathy is a rarely reported entity in children with an incidence of 0.5 to 6.2 %. Although dengue is a non-neurotropic virus, possibility of direct neuronal injury due to the dengue virus cannot be ruled out. We are here with two cases of dengue encephalopathy. Case summary: An 8-year-old girl presented with acute onset fever with rash, myalgia, and arthralgia and on evaluation was found to have hemoconcentration, leucopenia and thrombocytopenia. Dengue IgM was found to be positive. On day 3 of illness the child developed altered sensorium for around 24 hours and one episode of generalized seizure. CSF Examination was suggestive of viral etiology and neuro imaging was normal. Similarly, another 13-year-old boy with similar history and NS1 antigen positivity developed severe incapacitating headache lasting for around two weeks, more in retrorbital region. CSF examination showed mononuclear pleocytosis with normal sugar and protein. MRI brain showed mild gyral swelling in bilateral fronto temporal region. Fundus examination was normal in both the cases. Both the cases did not have significant hepatic dysfunction or coagulopathy and had normal serum electrolytes and recovered with symptomatic management and intravenous fluid therapy. Conclusion: Dengue is an emerging cause of encephalopathy competing with JE especially in non endemic areas. Clinicians need to be aware of this rare presentation of a common febrile illness like Dengue with encephalopathy, seizure and headache for timely identification and proper management. Key word: Encephalopathy; Encephalitis; Dengue -------------------------------------------------------------------------------------------------------------------------------------Date of Submission: 27-04-2020 Date of Acceptance: 10-05-2020 ------------------------------------------------------------------------------------------------------------------------------------