It is vital that clinicians look for dengue computer virus as a cause of transverse myelitis or other inflammatory neurologic manifestations in patients presenting with typical dengue fever symptoms and living in or visiting dengue-endemic areas. Acknowledgments Kathleen Louden, ELS, of Louden Health Communications provided editorial assistance. Footnotes Disclosure Statement The author(s) have no conflicts of interest to disclose.. Neurologic involvement owing to direct central nervous system involvement of the virus during the acute phase prospects to encephalitis, meningitis, and myelitis.4 The postinfection phase may be associated with acute disseminated encephalomyelitis, neuromyelitis optica, optic neuritis, Guillain-Barr syndrome, myelitis, oculomotor palsy, phrenic neuropathy, and chronic fatigue syndrome, with encephalitis being the most common. Involvement of the spinal cord appears to be rare and occurs mostly in the form of transverse myelitis. Spinal cord involvement in the form of longitudinally considerable transverse Oxibendazole myelitis (LETM) has been described only once in the literature to our knowledge.5 We report a case of LETM in a previously healthy middle-aged man presenting with dengue fever associated with bilateral lower limb weakness and urinary incontinence. The individual responded to corticosteroids and eventually experienced total neurologic recovery. CASE SUMMARY A 42-year-old man, a resident of an ongoing dengue outbreak area, presented with 4 days of fever and 1 day of bilateral lower limb weakness to the Emergency Department of Guru Teg Bahadur Hospital in Delhi, India. The fever was high grade with chills, myalgia, arthralgia, headache, and petechial rash. Bilateral lesser limb weakness that experienced developed 3 days after the onset of fever was associated with urinary retention. The motor weakness was associated with sensory impairment in the lower limbs extending to the level of the umbilicus. However, there was no associated bowel involvement. There was no history of bleeding tendency, recent vaccination, or unusual medical history. The patient was admitted to the hospital. Results of the general examination were unremarkable except for hyperthermia (heat = 38.9C [102F]) and multiple petechiae all over the body. Neurologic findings revealed flaccid paralysis of bilateral Oxibendazole lower limbs with hypotonia and muscle mass strength of 2/5 at the hip, knee, ankle flexors, and extensors. Deep tendon reflexes were absent, and Babinski sign was positive. Abdominal reflexes were absent. The level of sensory deficit extended upward until the umbilicus, corresponding to T10. Neurologic examination of Oxibendazole the upper limbs and the cranial nerves were normal. Initial laboratory investigations revealed a hemoglobin level of 10.2 g/dL, leukopenia (leukocytes = 3 103/L), and thrombocytopenia (platelets = 18 103/L). The platelet count increased during the hospital stay, without the need for transfusion. Results of the NS1 (non-structural protein 1) antigen test and the immunoglobulin M antibody test detected using a single-step immunochromatographic assay were positive for dengue. Cerebrospinal fluid analysis could not be carried out because the patient did not consent to a lumbar puncture. Table 1 denotes the laboratory investigations of the patient at hospital admission and at discharge. Magnetic resonance imaging of the spine revealed continuous intramedullary T2 hyperintense transmission intensity in the long segment of the dorsal cord extending from T5 to the conus medullaris and from your C2 to C4 level of the cervical spinal cord (Physique 1). Magnetic resonance imaging of the brain revealed unusual moderate diffuse cerebral atrophy. Open in a separate window Physique 1. Magnetic resonance image of spinal cord. Continuous intramedullary T2 hyperintense transmission intensity in the long segment of the dorsal cord extending from T5 to the conus medullaris and from your C2 Oxibendazole to C4 level of the cervical cord. Table 1. Laboratory Oxibendazole values at admission and discharge thead th valign=”middle” align=”left” rowspan=”1″ colspan=”1″ Investigation /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ At admission /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ At discharge /th /thead Hemoglobin (g/dL)10.212.5Total leukocyte count (103/L)33.4Platelet count (103/L)18265Blood glucose (mg/dL)103NASerum sodium (mEq/L)137134Serum potassium (mEq/L)4.74.1Serum calcium (mEq/L)7.38.4 Open in a separate window NA = unable Vasp to find a documented value in the documents. The patient was treated with supportive management and intravenous pulse therapy with methylprednisolone at a dosage of 1 1 g/day for 3 days and then was shifted.