Case StudyLongitudinal extensive transverse myelitis with cervical epidural haematoma following dengue virus infection

- First reported post-dengue paediatric longitudinal extensive transverse myelitis.
- Post-dengue epidural haematoma can have a good outcome without surgical decompression.
- Our report widens the neurological manifestation following dengue infection.
- Prompt immunomodulatory treatment needs to be given in parainfectious dengue LETM.

BackgroundLongitudinal extensive transverse myelitis associated with dengue infection is rare with no reported paediatric cases.MethodsWe report a 12-year-old girl who presented with flaccid quadriplegia 8 days after onset of acute dengue fever. MRI spine showed T2 hyperintensity associated with epidural hematoma at C3-C6 level of the spinal cord. Transcranial magnetic brain stimulation revealed absent motor evoked potentials bilaterally. We also summarise and compare the reported cases of transverse myelitis associated with dengue infection.ResultsImmunomodulatory treatment was given which included pulse methylprednisolone, intravenous immunoglobulin and plasmapharesis. Six months post-admission, there was a good (near-complete) clinical recovery with the repeat MRI showing mild residual hyperintensity at C4 level and complete resolution of epidural haematoma.ConclusionThis is the first reported paediatric case of longitudinal extensive transverse myelitis following dengue infection. It is also the first to illustrate that in patients with concomitant epidural haematoma a good outcome is possible despite not having surgical decompression. Clinicians should be aware of parainfectious dengue-related longitudinal extensive transverse myelitis in children and consider prompt immunomodulatory treatment.