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Acute transverse myelitis (ascending myelitis) as the initial manifestation of Japanese encephalitis: a rare

Varshney Ankur Nandan1, Kumar Nilesh, Behera Dibyaranjan

  • 1IMS BHU, Varanasi, India.

Case Reports in Infectious Diseases
|April 16, 2013
PubMed

Insights

Japanese encephalitis (JE) can rarely present as acute transverse myelitis (ATM). Early diagnosis and immunomodulator treatment in JE-endemic regions can improve outcomes for this rare presentation.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Japanese encephalitis (JE) is a common inflammatory brain disease in Southeast Asia.
  • Acute transverse myelitis (ATM) is an unusual initial manifestation of JE, rarely reported.
  • JE typically presents with fever, headache, seizures, and neurological deficits.

Purpose of the Study:

  • To report a rare case of Japanese encephalitis presenting initially as acute transverse myelitis in a 13-year-old boy.
  • To highlight the importance of considering JE in patients with ATM in endemic areas.
  • To emphasize the potential benefit of early immunomodulator treatment.

Main Methods:

  • Case report of a 13-year-old male with fever and acute onset paraparesis.
  • Diagnostic workup included brain and spinal MRI, and cerebrospinal fluid (CSF) analysis for JE virus IgM.
  • Treatment involved conservative management and intravenous methylprednisolone.

Main Results:

  • The patient presented with paraparesis, progressing to quadriparesis, followed by headache and altered sensorium.
  • MRI revealed significant edema in the basal ganglia, thalamus, internal capsule, midbrain, and spinal cord.
  • CSF analysis confirmed elevated IgM titres against JE virus.
  • The patient showed significant motor power recovery at 3 months but persistent neurological deficits.

Conclusions:

  • Acute transverse myelitis can be an initial, albeit rare, presentation of Japanese encephalitis.
  • Clinicians in JE-endemic regions should consider JE in patients presenting with ATM.
  • Early diagnosis and treatment with immunomodulators may improve survival and neurological outcomes.

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