Diagnostic challenges in dengue encephalitis: subtle imaging findings and initially negative laboratory test in a kidney transplant recipient

TL;DR

This paper discusses the difficulties in diagnosing dengue encephalitis in a kidney transplant patient, emphasizing subtle imaging and lab findings.

Contribution

The paper presents a case study and framework for diagnosing dengue encephalitis in immunocompromised patients.

Findings

Dengue encephalitis can present with atypical symptoms in immunocompromised individuals.

Subtle MRI changes and negative initial lab tests can delay diagnosis.

Timely recognition and proper interpretation of CSF findings are crucial for management.

Abstract

Dengue encephalitis is an uncommon neurological complication of dengue virus infection. In immunocompromised patients, such as solid organ transplant recipients, the clinical presentation may be atypical and nonspecific, posing significant diagnostic and therapeutic challenges. We report a clinical case and use it as a framework to discuss key considerations for suspicion of dengue encephalitis. Topics include optimal timing for clinical suspicion, essential differential diagnoses, and the most appropriate diagnostic strategies. Emphasis is placed on the correct interpretation of cerebrospinal fluid findings and recognition of subtle brain magnetic resonance imaging changes that may support the diagnosis. The discussion also reviews current evidence on dengue encephalitis in immunocompromised populations, highlighting implications for timely diagnosis and management in this vulnerable group.

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