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Case report
Ref Number: APCP-PP-285

Central and Peripheral Nervous System Involvement in Pediatric Chikungunya Infection: A Case of Encephalitis Followed by AMSAN-Guillain Barre syndrome

Shanika Rankoth¹, Vasana Kiridena², S Krishnapradeep², Sham Weerasinghe ³, Fous Lebbe³
1- Teaching Hospital Peradeniya, Sri Lanka 2- Faculty of Medicine, University of Peradeniya, Sri Lanka 3- Sirimavo Bandaranaike Specialized Children's Hospital, Sri Lanka
Corresponding Author: Shanika Rankoth (dilanishani158@gmail.com)
Abstract Body
Introduction: Chikungunya virus (CHIKV) is an emerging neurotropic arbovirus capable of causing significant neurological morbidity . While encephalitis and Guillain Barre syndrome (GBS) have been individually reported, sequential involvement of the central and peripheral nervous systems in children is exceptionally rare, particularly in axonal variants. Case presentation: A previously healthy 9-year-old boy developed fever and rash during a household chikungunya outbreak. Following subsidence of fever, he developed acute behavioral changes, hallucinations, and altered consciousness consistent with encephalitis. Within days, he progressed to rapidly ascending flaccid paralysis with sensory loss, urinary retention, and autonomic instability . Electroencephalography showed diffuse slowing, cerebrospinal fluid revealed cytoprotein dissociation, and serum chikungunya IgM was positive. MRI brain demonstrated mild generalized cerebral volume loss. Initial nerve conduction studies were normal, but repeat studies confirmed acute motor sensory axonal europathy (AMSAN), a severe axonal variant of GBS. He required intensive care, multiple courses of intravenous (IV)immunoglobulin, IV Rituximab, five cycles of plasma exchange, prolonged multidisciplinary care and rehabilitation. Conclusions: This case highlights the ability of chikungunya infection to cause a biphasic neurological illness with sequential encephalitis and AMSAN type GBS in a child. Clinicians in endemic regions should maintain a high index of suspicion for evolving peripheral neuropathy following chikungunya associated encephalopathy . Serial neurophysiological studies, early immunomodulatory therapy , and effective rehabilitation are critical to optimize outcomes.
Keywords: Amsan-guillain barre syndrome; Peripheral nervous system involvement; Chikungunya infection
Presentation Type: Case report
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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