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Final Program


Final Program

1105 - A Rare Case of Intracerebral hemorrhagic dengue with cervicothoracic spinal cord and cauda equina involvement in a pediatric patient with mitochondrial complex 1 deficiency

Friday, February 28, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • AR

    Andrew Rivera, N/A, MD

    Resident Physician
    Icahn School of Medicine at Mount Sinai
    New York, New York, United States

    • Co-Author(s)

  • AW

    Alvin H. Wang, BS

    Medical student
    Touro University California
    palo alto, California, United States

  • VS

    Vasant Sarthi, BA

    OMS-IV
    Philadelphia College of Osteopathic Medicine
    Newark, Delaware, United States

  • Miguel X. Escalon, MD

    Program Director
    Icahn School of Medicine at Mount Sinai
    NY, New York, United States

Case Diagnosis: Intracranial hemorrhage (ICH) is one of the rare manifestations due to Dengue virus and even more uncommon is its extension into the spinal cord and peripheral nervous system. We report the first known case of concomitant ICH and non-traumatic spinal cord injury with involvement of the cauda equina, due to dengue virus in a pediatric patient with Mitochondrial complex 1 deficiency.

Case Description: A 16-year-old male with Mitochondrial complex 1 deficiency presented with fever, headache, and arthralgias after exposure to Dengue virus in Mexico. His symptoms rapidly progressed to respiratory failure requiring mechanical ventilation. Neurological examination revealed bilateral lower extremity weakness, areflexia, and bowel/bladder incontinence. A brain MRI showed multifocal intracerebral hemorrhages, while spinal imaging revealed myelitis extending from the cervico-medullary junction to the conus medullaris, and affecting the cauda equina nerve roots.

Discussions: The neurological complications of dengue fever, particularly extensive involvement of both brain and entirety of the spinal cord, remain rare. The observed inflammation and hemorrhage throughout the spinal cord and cauda equina, as seen in this case, add to the limited understanding of Dengue's neuroinvasive potential. It is uncertain if the underlying Mitochondrial disease exacerbated the effects of dengue, or affected recovery. With therapy, the patient improved with ADLs including wheelchair transfers, ambulating with a roller walker, and control of bowel and bladder.

Conclusions:

The widespread spinal inflammation and encephalitis  underscore the neuroinvasive potential of dengue, particularly in a patient with a predisposing metabolic condition like mitochondrial NDUFV1 deficiency. Such a presentation has not been described and expands the clinical spectrum of Dengue-related complications and in the context of this mitochondrial disease. This case also informs both acute management and long-term rehabilitation strategies, given the profound functional deficits that may result from this unusual disease course.