Case Report: Guillain-Barré Syndrome Secondary to Dengue Virus Infection in Northeast Mexico
Fernando De la Garza-Salazar *
Department of Internal Medicine, Christus Muguerza Hospital Alta Especialidad, Universidad de Monterrey, Nuevo León, México.
Fernando Góngora-Rivera
Department of Internal Medicine, Christus Muguerza Hospital Alta Especialidad, Universidad de Monterrey, Nuevo León, México and Department of the Neurology, Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Mexico.
Hector Lopez-de la Garza
Department of Internal Medicine, Christus Muguerza Hospital Alta Especialidad, Universidad de Monterrey, Nuevo León, México.
Emma Purón-González
Department of Internal Medicine, Christus Muguerza Hospital Alta Especialidad, Universidad de Monterrey, Nuevo León, México.
Jorge Alberto Hernandez-Portales
Department of Internal Medicine, Christus Muguerza Hospital Alta Especialidad, Universidad de Monterrey, Nuevo León, México.
*Author to whom correspondence should be addressed.
Abstract
Aims: Dengue virus is a mosquito-born viral disease that infects about 390 million people each year. The clinical manifestations are fever, arthralgia and myalgia. Guillain-Barré Syndrome (GBS) caused by dengue fever has been rarely reported.
Presentation of Case: A 46-year-old man with no relevant medical history was seen because of progressive quadriparesis, dysautonomia, dysphagia and facial paresia. Ten days before seeking medical care the patient had fever, myalgia, arthralgia, rash, thrombocytopenia, and a positive NS1 dengue antigen. GBS was suspected and immunoglobulin was started while nerve conduction studies confirmed an acute motor axonal polyradiculoneuropathy. According to Brighton criteria, the patient was classified with a level 2 diagnostic certainty, since it was decided to not perform lumbar puncture for CSF analysis. The patient had a good clinical response and was subsequently discharged.
Discussion: Dengue virus is arthropod-borne. It presents with high fever, rash, arthralgia, myalgia, and in rare cases, neurological complications such as GBS. In Mexico, there were 14,112 confirmed cases of non-severe dengue and 3,683 cases of severe dengue or with warning signs in 2016. There are no reported cases of GBS secondary to dengue infection in this country.
Conclusion: GBS following dengue fever should be considered in countries with a high incidence of dengue infection such as Mexico even if there are no previous manifestations of dengue fever.
Keywords: Guillain-Barré syndrome, dengue fever, flavivirus, neurological manifestations of dengue