Acute Demyelinating Encephalomyelitis in a Neonate Secondary to Dengue Infection.

A 9-day-old term male neonate was referred to us with history of fever, lethargy, poor feeding and seizures. The neonate was delivered by elective caeserian section, and weighed 2.98 kg at birth. The mother was treated for undiagnosed febrile illness before the delivery which lasted for a week. On 6th day of life, the child was readmitted in view of poor feeding and fever. Septic workup was negative. The platelet count decreased from 2.35 × 109/L to 1.3 × 109/L on day 9 of life. Repeat septic work-up was negative. Basic biochemistry work-up for seizure was normal. Analysis of cerebrospinal field (CSF), including polymerase chain reaction (PCV) for herpes simplex virus (HSV) was negative. Neurosonogram revealed normal study. Platelet count further dropped to 1.1 x 109/L on day 11 of life. Dengue panel revealed positive NS1 antigen, positive IgG and negative IgM antibodies against dengue virus. Magnetic resonance imaging (MRI) of brain revealed multiple areas of restricted diffusion of the white matter of the supratentorial compartment involving the fronto parietal and temporal lobes as well as the internal capsules. A diagnosis of acute demyelinating encephalitis (ADEM) was made based on findings of MRI. A metabolic screen (ammonia, lactate and tandem mass spectroscopy) was negative. The neonate received respiratory support and anticonvulsants (phenobarbitone and phenytoin) for seizures. Fever resolved by 10th day, platelet counts normalized by 14th day and seizures were well controlled. Virus isolation for dengue could not be performed. As the Acute Demyelinating Encephalomyelitis in a Neonate Secondary to Dengue Infection sensorium was normalized and seizures were well controlled, further immunotherapy was not initiated. The neonate was discharged on 17th day of life. The anticonvulsants were tapered and stopped over next 4 weeks. Repeat MRI brain was not advised as the follow up neurological and developmental examination was normal at 3 months of life.