Spontaneous spinal epidural hemorrhage due to dengue fever causing hemiparesis in a non-endemic zone: A case report

TL;DR

A man in a non-dengue-endemic area developed spinal bleeding from dengue fever, leading to partial paralysis, highlighting the disease's rare and severe neurological effects.

Contribution

This is the first reported case of dengue-induced spinal epidural hemorrhage with hemiparesis in a non-endemic region.

Findings

Dengue fever can cause rare neurological complications like spinal epidural hemorrhage in non-endemic zones.

The patient presented with hemiparesis, differing from prior cases that showed quadriplegia or paraplegia.

Early screening for tropical fevers is crucial in non-endemic regions with expatriate populations.

Abstract

Dengue is the most common arthropod-borne viral illness in humans and is prevalent in tropical and subtropical regions worldwide. Nearly half of the world’s population living in these endemic areas is at risk of infection.

Case presentation: A 42-year-old Bangladeshi male, previously healthy and working as a laborer, was admitted to Hazm Mebaireek General Hospital—a Qatar government hospital serving mainly laborer populations—with a 3-day history of abdominal pain, fever, and intermittent vomiting. He had no recent history of travel to Bangladesh before this incident. Viral studies were positive for dengue virus immunoglobulin G and immunoglobulin M. Magnetic resonance imaging revealed a posterior extradural collection extending from cervical (C) 3 to dorsal (T) 7, resulting in compression of the posterior aspect of the thecal sac and causing it to appear off-center within the spinal canal. The findings suggested that the collection was most likely infective in origin. He underwent a right-sided C7 hemilaminectomy and evacuation of an epidural hematoma at Hamad General Hospital, Qatar. Postoperatively, he improved significantly. He was subsequently transferred to the Qatar Rehabilitation Institute for an active rehabilitation program and was discharged upon completion of rehabilitation.

Discussion: Dengue is prevalent in subtropical regions and South America, accounting for nearly 75% of global cases. Qatar is a non-endemic zone for dengue fever. Spinal cord epidural hematoma due to dengue fever is extremely rare, with only five cases reported to date according to our literature review. Our case will be the 22nd reported instance—and the sixth among similar series—of spontaneous spinal hemorrhage due to dengue in the literature, and the first reported from a non-endemic zone. The neurological manifestation in our case was hemiplegia. Among the five previously reported cases, two presented with quadriplegia and three with paraplegia.

Gulf countries are at particularly high risk among non-endemic regions due to the large number of expatriates returning from endemic areas. This case indicates that atypical presentations of dengue can also occur in non-endemic regions. We believe that early screening for tropical fevers in suspected cases can facilitate prompt diagnosis and management of dengue fever. To our knowledge, this is the first reported case of spinal hemorrhage due to dengue fever from a non-endemic zone. Moreover, our patient presented with hemiparesis, whereas the four previously reported cases manifested as either quadriplegia or paraplegia.

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