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Rare case of dengue encephalitis with extensive brain lesions from Pakistan
  1. Taimoor Hussain1,2,
  2. Zaraq Rashid3,
  3. Jasvindar Kumar4 and
  4. Daneet Kumar3
  1. 1Neurology, Bolan Medical College, Quetta, Baluchistan, Pakistan
  2. 2Neurology, Yale University, New Haven, Connecticut, USA
  3. 3Internal Medicine, Hayatabad Medical Complex, Peshawar, Pakistan
  4. 4Internal medicine, Khyber Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan
  1. Correspondence to Dr Taimoor Hussain; taimoor_naran{at}


Dengue infection is common in 129 countries including Pakistan, with an estimated 390 million dengue virus infections per year. Asia accounts for 70% of the actual burden. Clinical signs and symptoms of dengue include a high fever (40°C/104 °F) accompanied by two of the following symptoms during the febrile phase: severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands and rash. Severe dengue is a potentially fatal complication, due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding or organ impairment. Dengue virus does not usually cause neurological manifestations, unlike other arboviral infections. Encephalopathy is the most common neurological complication. Encephalitis is rare manifestation. We report a rare case of dengue encephalitis from Pakistan, with extensive brain lesions involving the thalamus, cerebellar vermis and frontoparietal periventricular regions. Therefore, we suggest dengue encephalitis should be considered in the differential diagnosis of fever with altered sensorium, especially in Asian countries such as Pakistan where dengue is rampant as dengue encephalitis can be fatal at times.

  • General practice / family medicine
  • Tropical medicine (infectious disease)
  • Neurology
  • Infection (neurology)

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  • Twitter @Jasvindar Kumar

  • Contributors ZR, DK and JK participated in data collection; TH and ZR drafted the manuscript; ZR, TH, JK and DK performed the literature search, critically reviewed the manuscript and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.