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Case Studies | Medical Science | India | Volume 13 Issue 10, October 2024 | Rating: 4.4 / 10
A Rare Convergence: Dengue Maculopathy and Encephalopathy in a Diabetic Patient
Dhvani Pankaj Kumar Trivedi | Rudra Pankajkumar Trivedi [2] | Dr. Heti Mistry [2]
Abstract: Dengue fever, caused by Flaviviridae RNA virus, ranges from asymptomatic to multiple - organ dysfunction. ? Dengue typically presents with symptoms like fever, myalgia, headache, vomiting, low platelets, and positive NS1 test. Rarely, it can also cause ocular issues like macular edema, retinal haemorrhage? and neurological manifestations such as encephalopathy, due to complications like shock and hepatitis; both of which were observed in our patient. A 35-year-old diabetic male with severe dengue fever presented with fever with chills, body aches, headache, joint pain and burning micturition for 3 days. On Day 4, he experienced sudden, painless blurred vision in both eyes, along with vomiting, generalised weakness, and a non - palpable rash. He had generalised swelling with redness. Ocular examination revealed reduced visual acuity and macular edema in both eyes. Patient shows initial normal Hb, hematocrit, and WBC. By Day 4, there's severe thrombocytopenia, elevated liver enzymes and coagulation abnormalities. MRI showed focal diffusion restriction in the splenium of the corpus callosum, consistent with Mild Encephalopathy with Reversible Splenial Lesion (MERS). Dengue NS1 was positive. Initially managed with aggressive fluid resuscitation and symptomatic care, then treated with systemic corticosteroids (dexamethasone) for ocular and neurological symptoms, alongside levetiracetam for seizure prevention. Corticosteroids minimise structural damage and prevent vision loss from ocular inflammation caused by an immune response. ? Vitamin K corrected coagulation issues, and additional treatment included Nepafenac eye drops, topical NSAIDs, and multivitamins. Blood glucose levels were closely monitored and controlled with insulin due to diabetes. By Day 8, the patient showed significant improvement and was discharged with complete recovery. We report a rare case of a 35-year-old diabetic male with dengue fever, presenting with both maculopathy and mild encephalopathy with reversible splenial lesion (MERS). MERS may have either infectious or non - infectious causes like hypernatremia, hypoglycemia, withdrawal of anti - epileptic drugs and so on. ? Timely recognition of dengue as a potential cause by the physician is vital for initiating appropriate treatment, leading to faster recovery and disease remission.
Keywords: dengue fever, maculopathy, mild encephalopathy, thrombocytopenia, dengue treatment
Edition: Volume 13 Issue 10, October 2024,
Pages: 520 - 522