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Open Access Case report

Paralytic squint due to abducens nerve palsy : a rare consequence of dengue fever

Mitrakrishnan C Shivanthan*, Eranda C Ratnayake, Bandula C Wijesiriwardena, Kalum C Somaratna and Lakmal KGK Gamagedara

Author Affiliations

Wards 45 & 46 A, National Hospital of Sri Lanka, Regent Street, Hospital Square, Colombo, Sri Lanka

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BMC Infectious Diseases 2012, 12:156  doi:10.1186/1471-2334-12-156

Published: 16 July 2012

Abstract

Background

Dengue fever is an endemic illness in the tropics with early and post infectious complications affecting multiple systems. Though neurological sequelae including mononeuropathy, encephalopathy, transverse myelitis, polyradiculopathy, Guillain-Barre syndrome , optic neuropathy and oculomotor neuropathy have been reported in medical literature, the abducens nerve despite its notoriety in cranial neuropathies in a multitude of condition due to its long intracranial course had not been to date reported to manifest with lateral rectus paralysis following dengue.

Case presentation

A previously well 29 year old male with serologically confirmed dengue hemorrhagic fever developed symptomatic right lateral rectus palsy during the critical phase of the illness, which persisted into convalescence and post convalescence with proven deficit on Hess screen. Alternate etiologies were excluded by imaging, serology and electrophysiology.

Conclusions

The authors detail the first reported case of abducens nerve palsy complicating dengue fever in a previously healthy male from Sri Lanka. In a tropical country with endemic dengue infections, dengue related abducens neuropathy may be considered as a differential diagnosis in cases of acquired lateral rectus palsy after dengue fever.

Keywords:
Dengue fever; Squint; Abducens palsy