Abstract Details

Title Optic Perineuritis and Central Nervous System Vasculitis Induced after Dengue Infection

Topic Autoimmune Neurology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-043

Objective NA

Background Dengue infection is an arboviral disease which pathophysiological mechanisms responsible for its effects on CNS have not yet been fully elucidated.

Design/Methods NA

Results In March 2016, a white woman, 57-year-old, had arthralgia, fever, myalgia and was diagnosed with dengue virus infection (ELISA). After 15 days, she presented ocular pain and visual loss in both eyes and was diagnosed with bilateral optic neuritis. She received pulse therapy treatment with methylprednisolone IV 1g/day for 5 days and got improvement of her visual loss. After 3 days of hospital discharge, without prednisone, she worsened bilateral visual acuity and had to start a new pulse therapy with methylprednisolone 1g/day for 7 days and discharged from the hospital with prednisone 80mg/day orally. Since then, any attempt to decrease the corticosteroid dose worsened her visual acuity. Patient presented normal neurological examination, except for bilateral optic nerve alterations: normal pupils, but reduced photopupillary reflex, VA <0.1 in both eyes and bilateral optic disc pallor in the fundus (larger in left eye); Laboratory tests: normal CSF; negative serologies for Hepatitis B/C, HIV, VDRL; normal vitamin B12, B9 and methylmalonic acid; normal thyroid and liver functions; normal rheumatologic tests (ANA, ENA, RF, antiphospholipid antibodies, c-ANCA, p-ANCA) and CRP; negative AQP4 (CBA method). MRI showed meningeal (pachymeningitis) and optic nerve sheath (optic perineuritis) enhancement to Gd, as well as oval lesion with hypointense T1 and hyperintense T2/FLAIR, and enhancement of Gd in T1, in addition to DW1 (+) in right subcortical white matter suggesting vasculitis of CNS. Started treatment with azathioprine 200mg/day, with progressive decrease of prednisone, but during treatment in 2017 she presented hypercalciuria 350mg/24-hour and serum ACE 90U/L, suggesting sarcoidosis.

Conclusions

We described a rare autoimmune complication of Dengue infection, first treated as pachymeningitis and optic perineuritis, but subsequently defined as neurosarcoidosis.

Authors/Disclosures
Thales S. Da Matta PRESENTER	No disclosure on file
Fernando J. Baratela	No disclosure on file
	No disclosure on file
Nilo O. Masocatto, Sr.	No disclosure on file
	No disclosure on file
Pedro L. Mendes	No disclosure on file
Ana C. Piccolo, MD (PICCOLO)	No disclosure on file

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