Acute flaccid paralysis as the initial manifestation of Japanese encephalitis: a case report.

Japanese encephalitis (JE) is an inflammation of the central nervous system resulting in clinical disease, with symptoms ranging broadly in severity from mild febrile illness to acute meningomyeloencephalitis. JE has been associated with a variety of neurological abnormalities such as altered sensorium, seizures, focal neurological deficit, and acute flaccid paralysis (AFP). However, AFP has never been reported as the initial manifestation of JE. Here we present a case of AFP as the initial manifestation of JE in a Chinese patient. A 30-year-old Chinese man was admitted to West China Hospital of Sichuan University after experiencing AFP in the right upper limb followed by hyperpyrexia and unconsciousness. Assay of cerebrospinal fluid from lumbar puncture revealed high levels of proteins and anti- Japanese encephalitis virus IgM antibodies. Acyclovir (used by intravenous drip) was administered. However, the weakness persisted and more extensive muscle wasting from the proximal to distal right upper limb occurred during seven months. This case reports highlights that JE needs to be added to the differential diagnosis of AFP initiating in an adult in JE endemic seasons and areas.