PDF(Pubmed)
Abstract：
Dengue is a systemic viral infection, and clinical findings vary from asymptomatic to life-threatening, including shock and neurological complications. Despite efforts in vector control, the disease continues to spread worldwide, and the number of annual dengue infections is estimated to be 390 million. For patients with severe dengue, early diagnosis is important; however, owing to the wide range of symptoms and severity, diagnosis can be difficult. Herein, we report the case of a 24-year-old man from Vietnam who was found to have dengue shock syndrome complicated by meningoencephalitis, even though he did not show the typical clinical manifestations of dengue infection. He was transported to our hospital by ambulance because of fever and altered mental status. Brain magnetic resonance imaging revealed hyperintensities in the bilateral thalamus and brainstem on the T2 sequence. After hospitalization, polymerase chain reaction testing of cerebrospinal fluid, serum, and urine revealed the presence of dengue virus serotype 2. This confirmed the diagnosis of dengue encephalitis. The patient was discharged on day 49 with impaired abduction of the left eye and urinary retention. In this case, the initial differential diagnosis was broad because the patient was unable to provide any medical history owing to altered mental status. In addition, the fact that he did not show the characteristic symptoms of dengue infection initially made the diagnosis very difficult. In conclusion, dengue fever should always be considered as a part of the differential diagnosis when a patient from an endemic area presents with fever and impaired consciousness.
摘要：
登革热是一种全身性病毒感染,临床表现从无症状到危及生命，包括休克和神经系统并发症.尽管在病媒控制方面做出了努力，这种疾病继续在全世界蔓延，每年登革热感染人数估计为3.9亿。对于患有严重登革热的患者，早期诊断很重要；然而，由于广泛的症状和严重程度，诊断可能很困难。在这里，我们报道了一名来自越南的24岁男子的病例，他被发现患有登革热休克综合征并伴有脑膜脑炎，尽管他没有表现出典型的登革热感染的临床表现。由于发烧和精神状态改变，他被救护车送往我们医院。脑磁共振成像显示T2序列上双侧丘脑和脑干的高强度。住院后,脑脊液聚合酶链反应试验，血清,尿液显示存在2型登革热病毒。这证实了登革热脑炎的诊断。患者在第49天出院，左眼外展受损，尿潴留。在这种情况下,最初的鉴别诊断是广泛的,因为患者由于精神状态改变而无法提供任何病史.此外,他最初没有表现出登革热感染的特征性症状，这使得诊断非常困难。总之,当来自流行区的患者出现发烧和意识障碍时，应始终将登革热视为鉴别诊断的一部分。
