Kaluhath Gayathree Lalanga De Abrew ¹, Ayesha Yaddahi¹, Sampath Senavirathne¹, Shenoli Wijesinghe¹, Rasika Gunapala¹, Deshan Adihetti¹, Pyara Rathnayake ¹, Nalin kithulwaththa ¹
1- Lady Ridgeway Hospital, Sri Lanka
Corresponding Author:
Kaluhath Gayathree Lalanga De Abrew (
gayathreemfc@gmail.com)
Abstract Body
Introduction: Chikungunya virus is an arthropod-borne infection that typically causes a selflimiting febrile illness. Neurological complications are uncommon.These may include encephalitis, myelitis, and immune-mediated conditions such as Bickerstaff brainstem encephalitis (BBE). Early recognition is important, as timely immunotherapy can significantly improve outcomes.
Case presentation: An 18-month-old previously healthy boy presented with five days of highgrade fever and diarrhea, followed by irritability , progressive bilateral ptosis, bulbar symptoms, and generalized motor weakness. Neurological examination revealed hypotonia with hyperreflexia and bilateral extensor plantar responses. Thereafter he developed respiratorycompromise requiring elective ventilation. MRI brain findings were suggestive of encephalitis, while nerve conduction studies showed reduced motor responses with preserved sensory conduction, consistent with myelitis. Chikungunya IgM was positive. After initial antibiotics, he was treated with intravenous immunoglobulin, methylprednisolone, and therapeutic plasmaexchange, leading to gradual clinical improvement.
Conclusion: This case highlights a rare presentation of chikungunya-associated encephalomyelitis mimicking BBE in a young child. Clinicians in endemic areas should maintain a high index of suspicion for neuroinvasive chikungunya in children with acute brainstem or motor symptoms, as early immunotherapy can lead to favorable outcomes.