A Case of Japanese Encephalitis with Neuroendocrine Complication

Abstract

A four years old male child, presented with history
of fever, altered sensorium for 4 days following a recent
history of travel. Child had seizures on the day of admission,
CSF analysis done on day one showed few lymphocytes but
protein and sugars were normal. Serology for JE done ten
days later was IgM ve. MRI brain showed hyper intensities in
Basal ganglia and left corona radiata. On day-2 child
developed status epileptics and child was intubated. Planned
extubation on day-9 failed, he was reintubated and
tracheostomy was done at a later date. On 20th day of
admission child developed polyuria. Clinically child was
dehydrated investigation showed low serum sodium high
urine sodium. Cerebral salt wasting was considered. Treated
with normal saline. Polyuria with dehydration persisted and
child was started on Fludrocortisone. After that urine sodium
reduced normal but polyuria was increasing. Hence central
diabetes insipidus was considered. Plasma osmolality
reduced and urine osmolality increased following
subcutaneous vasopressin. Urine output was adequately
replaced with saline and dextrose.
In view of persisting polyuria Tablet Desmopressin was
started and the polyuria settled in four days. Child was
continued to be under ventilatory support. On 76th day child
was weaned from ventilator and day 90 feeding tube was
removed. On the 95th day of discharge child recognises and
smiles at parents takes oral feeds. Tone increased in all four
limbs and residual facial nerve weakness was present. The
problem we faced in this child weaning and ventilator failure,
cerebral salt wasting and central diabetes insipidus.