Unilateral lateral rectus palsy following dengue: a case report

Area of Science:

• Ophthalmology
• Neurology
• Infectious Diseases

Background:

• Dengue fever is a significant public health concern in tropical regions, primarily known for its systemic and hemorrhagic manifestations.
• Neurological complications of dengue, though less common, can present with diverse clinical features, impacting various cranial nerves.

Observation:

• A rare case of an 18-year-old male presenting with lateral rectus palsy (paralytic squint) and uniocular diplopia after severe dengue infection is detailed.
• The patient experienced multiple organ dysfunction syndrome (MODS) initially, followed by the onset of ophthalmic symptoms upon recovery from the acute phase.
• Ophthalmological examination revealed right esotropia and diplopia, with normal neuroimaging, ruling out other potential causes.

Findings:

• The patient was diagnosed with lateral rectus palsy secondary to severe dengue, a complication not previously documented in Nepal.
• Management involved expectant care and subsequent treatment with prednisolone, leading to gradual improvement in esotropia and diplopia.
• This case underscores the potential for dengue to cause specific neurological deficits affecting ocular motility.

Implications:

• Ophthalmic manifestations, such as paralytic squint, should be considered in the differential diagnosis of patients with severe dengue, especially in endemic areas.
• Early identification and management of these rare neurological complications of dengue fever are essential for improving patient outcomes.
• Further research is warranted to elucidate the pathophysiology and establish optimal treatment protocols for dengue-associated ophthalmic nerve palsies.