Post-dengue parkinsonism
Shahrul Azmin?, Ramesh Sahathevan*?, Zainudin Suehazlyn?, Zhe Kang Law?, Remli Rabani?, Wan Yahya Nafisah?,
Hui Jan Tan? and Mohamed Ibrahim Norlinah?
Abstract
Background: Dengue is a common illness in the tropics. Equally common are neurological complications that stem from dengue infection. However, to date, parkinsonism following dengue has not been reported in medical
literature.
Case presentation: A previously well 18-year old man developed parkinsonism, in addition to other neurological symptoms following serologically confirmed dengue fever. Alternative etiologies were excluded by way of imaging and blood investigations.
Conclusions: The authors detail the first reported case of parkinsonism complicating dengue fever. Keeping rare presentations of common illnesses in mind, it behoves clinicians to consider parkinsonism as a complication following dengue infection. This would prevent injudicious treatment with L-dopa and dopamine agonists.
Immunosuppression with steroids has been shown to be helpful in certain cases.
...
One-way to explain this unusual phenomenon is the
?double-hit? hypothesis. It is known that influenza virus
has the capability to prime the innate CNS immune system
[18]. If varicella zoster virus has the same capability
in up-regulating the CNS immune system, a ?second-hit?
in the form of dengue fever may explain why our patient
was afflicted with such diverse neurological manifestation,
namely, parkinsonism, multiple cranial neuropathies, cerebellar
ataxia and plexopathy.
Conclusions
This is the first reported case of parkinsonism in a patient
who had dengue fever. Furthermore, our patient developed
an extensive variety of neurological manifestations in
addition to parkinsonism. The question of whether varicella
zoster and dengue virus co-infection confers any
prognostic significance on post-infectious neurological
manifestations needs to be investigated further. Finally, in
terms of treatment, immunosuppression with intravenous
methylprednisolone may be useful in selected cases in
aborting neurological progression and hastening recovery.
