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Myelitis with flaccid paralysis due to Japanese encephalitis: case report and review of the literature.

Authors
  • Grewe, Steven1
  • Gliem, Michael2
  • Abrar, Daniel B3
  • Feldt, Torsten1
  • Wojtecki, Lars4, 5
  • Tan, Victor6
  • Lifea,7
  • Afzal, Shazia8
  • Meuth, Sven G2
  • Luedde, Tom1
  • Orth, Hans Martin9
  • 1 Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany. , (Germany)
  • 2 Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany. , (Germany)
  • 3 Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany. , (Germany)
  • 4 Department of Neurology and Neurorehabilitation, Hospital Zum Heiligen Geist, Kempen, Germany. , (Germany)
  • 5 Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany. , (Germany)
  • 6 Department of General Medicine, BIMC Hospital, Bali, Indonesia. , (Indonesia)
  • 7 Department of Neurology, BIMC Hospital, Bali, Indonesia. , (Indonesia)
  • 8 Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany. , (Germany)
  • 9 Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany. [email protected] , (Germany)
Type
Published Article
Journal
Infection
Publisher
Springer-Verlag
Publication Date
Apr 09, 2022
Identifiers
DOI: 10.1007/s15010-022-01815-w
PMID: 35396695
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Japanese encephalitis is an arthropod-borne zoonotic flavivirus infection endemic to tropical and subtropical Asia. A minority of infections leads to a symptomatic course, but affected patients often develop life-threatening encephalitis with severe sequelae. Myelitis with flaccid paralysis is a rare complication of Japanese Encephalitis, which-according to our literature search-was reported in 27 cases, some of which were published as case reports and others as case series. Overall, there is a broad clinical spectrum with typically asymmetric manifestation and partly severe motor sequelae and partly mild courses. Lower limb paralysis appears to be more frequent than upper limb paralysis. An encephalitic component is not apparent in all cases CASE PRESENTATION: We herein add the case of a 29 year-old female who developed encephalitis and myelitis with flaccid paralysis during a long-time stay in Indonesia. Diagnostic workup in Indonesia did not clearly reveal an underlying cause. Upon clinical stabilization, the patient was evacuated to her home country Germany, where further diagnostics confirmed Japanese encephalitis virus as the causative agent. The patient has partly recovered, but still suffers from residual paralysis of the upper limb. Flaccid paralysis is a rare, and likely underdiagnosed complication of Japanese encephalitis, which, to the best of our knowledge, has never been diagnosed outside endemic areas before. © 2022. The Author(s).

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