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Case Report: Post-Chikungunya–Associated Myeloneuropathy

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  • 1 Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India;
  • | 2 Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India

ABSTRACT.

Chikungunya virus (CHIKV) is an arbovirus endemic to South Asia with frequent outbreaks. A wide spectrum of neurological complications has been described in Chikungunya infections. Myeloneuropathy is a rare complication seen in Chikungunya and is proposed to have an underlying immune mediated pathogenesis. We report a case of a 45-year-old man presenting to the emergency services with acute onset of quadriparesis, breathlessness, urinary retention, profound pain, and sensory disturbances 6 weeks after the onset of high-grade fever and arthralgia. On examination, the patient had Medical Research Council grade 1 flaccid quadriparesis with prominent wasting and areflexia with distinct sensory level at T4. Immunoglobulin M CHIKV antibodies were positive, tested twice at a 1-week interval. He had notable magnetic resonance imaging (MRI) findings in the form of patchy T2 hyperintensities involving the entire length of the cervical and thoracic cord with normal brain imaging and extensive short tau inversion recovery hyperintense signal changes on muscle MRI. He was treated with five cycles of plasmapheresis and intravenous methylprednisolone followed by oral steroids for 8 weeks. At 20-week follow-up, the patient had improvement in upper limb weakness, but paraparesis persisted. The case highlights the presence of unusual MRI findings and also the importance of early recognition of after infective neurological complications, and prompt treatment with immunomodulation may be beneficial.

Author Notes

Address correspondence to Seena Vengalil, Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India. E-mail: seenavengalil@gmail.com

Authors’ addresses: Ameya Patwardhan, Atchayaram Nalini, Haripriya Krishnareddy, Debayan Dutta, Tanushree Chawla, Ravindranadh Mundlamuri Chowdary, Ravi Yadav, and Seena Vengalil, Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India–560029, E-mails: ameya3892@gmail.com, atchayaramnalini@yahoo.co.in, haripreya@gmail.com, debd26021991@gmail.com, drtnshr.chaw@gmail.com, mravindranadhchowdary@gmail.com, docravi20@yahoo.com, and seenavengalil@gmail.com. Priyanka Priyadarshini Baishya and Karthik Kulanthaivelu, Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India–560029, E-mails: priyankapriyadarshini1986@gmail.com and pammalkk@gmail.com.

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