Diaphragmatic paralysis: a rare consequence of dengue fever

We report a middle aged patient from urban Sri Lanka who developed diaphragmatic paralysis secondary to phrenic neuropathy a month after recovering from dengue fever. He was managed conservatively and made a full recovery subsequently.Isolated phrenic nerve palsy causing diaphragmatic paralysis should be considered a recognized complication of Dengue fever. A patient usually gains full recovery with conservative management.Dengue virus infections are known to manifest in three main forms: - Dengue with or without warning signs and severe Dengue fever [1]. All three presentations of the disease usually recover uneventfully if accepted protocols are adhered to [2]. Uncommon manifestations of dengue fever, including neurological sequelae such as mononeuropathy, encephalopathy, transverse myelitis, polyradiculopathy and Guillain-Barre syndrome [3-5] have also been recognized in the past.A middle aged businessman from Colombo, Sri Lanka was admitted with a four day history of high fever, retro-orbital pain, athralgia and myalgia. He had no cough on admission and did not complain of breathlessness. He denied any bleeding manifestations including passing black stools. He also denied any recent travel to Malaria endemic regions in the country but had recently traveled to China on a business visit. He had no previous co-morbidities of significance. His physical examination was unremarkable on admission apart from a body temperature of 38.4°Celsius. His full blood count revealed a total white blood cell count of 5000/mm3 with normal differentials, hemoglobin 17.4 g/dl with evidence of hemoconcentration (PCV 52%) and thrombocytopenia with a platelet count of 60,000/mm3. The platelet count dropped to a low of 20,000/mm3 before recovery but the patient did not develop any significant bleeding manifestations. Chest X-ray on admission was normal (Figure 1).Dengue fever was confirmed with a positive dengue polymerase chain reaction (PCR) result and positive Dengue IgM antibodies. H