Dengue virus infection presenting with diffuse brain hemorrhage

Infecção pelo virus da dengue se apresentando com hemorragia cerebral difusa

A 40-year-old woman presented to the emergency department with acute decreased level of consciousness, associated with respiratory failure. She has complained of headache, fever, myalgia and dyspnea for the last seven days. Neurological examination disclosed decreased level of consciousness. Brain CT scan disclosed multiple intracerebral acute hemorrhage lesions (Figure). After extensive investigation, serologic test confirmed Dengue virus infection.

Brain involvement in dengue virus infection may have variable presentation, and encephalitis is the most common^1-3. However, although unusual, patients may present with cerebral hemorrhage, particularly in hemorrhagic dengue^4,5. Pathophysiology may include: capillary hemorrhage, disseminated intravascular coagulation and cerebral edema⁴.

Figure
Axial brain CT scan discloses bilateral and asymmetrical subcortical (straight arrows) and pericallosal (curved arrows) hemorrhage predominant in frontal and temporal lobes.

References

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  Puccioni-Sohler M, Rosadas C, Cabral-Castro MJ. Neurological complications in dengue infection: a review for clinical practice. Arq Neuropsiquiatr. 2013;71(9B):667-71. http://dx.doi.org/10.1590/0004-282x20130147
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  Souza LJ, Martins AL, Paravidini PC, Nogueira RM, Gicovate Neto C, Bastos DA et al. Hemorrhagic encephalopathy in dengue shock syndrome: a case report. Braz J Infect Dis. 2005;9(3):257-61. http://dx.doi.org/10.1590/s1413-86702005000300009
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Publication Dates

• Publication in this collection
  Oct 2014

History

• Received
  13 May 2014
• Reviewed
  27 June 2014
• Accepted
  17 July 2014