Encephalitis associated with inappropriate antidiuretic hormone secretion due to chikungunya infection in Recife, State of Pernambuco, Brazil

Lucena-Silva, Norma; Assunção, Maria Elisa Lucena Sales de Melo; Ramos, Frederico Antônio Pereira; Azevedo, Fernanda; Lessa, Ronaldo; Cordeiro, Marli Tenório; Brito, Carlos Alexandre Antunes de

doi:10.1590/0037-8682-0434-2016

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Cases Reports • Rev. Soc. Bras. Med. Trop. 50 (03) • May-Jun 2017 • https://doi.org/10.1590/0037-8682-0434-2016 copy

Encephalitis associated with inappropriate antidiuretic hormone secretion due to chikungunya infection in Recife, State of Pernambuco, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The symptoms of chikungunya virus (CHIKV) infection include fever, headache, muscle aches, skin rash, and polyarthralgia, characterized by intense pain, edema, and temporary functional impairment. This is the first report of encephalitis caused by CHIKV infection associated with an atypical presentation of syndrome of inappropriate antidiuretic hormone secretion, evolving to cognitive impairment and apraxia of speech.

Keywords:
CHIKV; Encephalitis; Syndrome of inappropriate antidiuretic hormone hypersecretion

	February 24^th	February 27^th	February 29^th	March 1^st	March 3^rd , 4^th	March 6^th , 7^th	March 9^th
Clinical	blisters	dehydration	hyponatremia	coma	conscious	cognitive deficit	discharged from ICU
*Blood cell count (ref)**
erythrocytes (3.9-5.4 million/µL)	3.29	4.03	3.65	3.93	3.27	3.54	3.57
hematocrit (35-47%)	28.5	34	31.1	34.5	28	30.1	30
hemoglobin (12-16g/dL)	9.8	11.5	10.6	11.7	9.8	10.3	10.1
leukocytes ( 4,000-11,000/ µL)	3,900	3,000	3,800	8,100	7,500	7,300	5,500
platelets (140,000-450,000/ µL)	225,000	260,000	282,000	303,000	332,000	334,000	386,000
Hydroelectrolytic balance (*ref)
sodium (136-145mEq/L)		121	119	103	133	132	137
chloride (98-107mEq/L)		86	82	69	105	95	99
bicarbonate (21-32mmol/L)		25	21	16	19	24	25
potassium (3.5-5.1mEq/L)		3.8	4	3.1	4.1	3.9	3.7
calcium (8.6-10.0mg/dL)			8.2	7.4	8	8.5	8.7
phosphorus (2.5-4.8mg/dL)				2.1	5.8	3.7	3.8
magnesium (1.2-2.6mg/dL)				1.5		1.7	1.7
Liver function and other tests (*ref)
albumin (3.4-4.8g/dL)		4	4		2.7		3.3
aspartate aminotransferase (15-37UI/L)	31	77	92	131	64	96	60
alanine aminotransferase (6-45UI/L)	44	76	162	274	168	116	107
lactate dehydrogenase (81-234U/L)			306
gamma-glutamyl transpeptidase (5-55UI/L)			77
direct bilirubin (up to 0.2mg/mL)		0.1	0.1	0.2		0.1	0.1
indirect bilirubin (0.1-1.0mg/mL)		0.1	0.4	0.4		0.3	0.2
amylase (25-115UI/L)	55
lipase (73-393UI/L)	138
Inflammation markers/others (*ref)
C-reactive protein (< 0.30mg/dL)	6.11	0.64	0.35	0.22	7.39	1.72	2.18
creatine phosphokinase (26-192U/L)				323		2,272	249
erythrocyte sedimentation rate (0-15mm)		14	14
ferritin (4.6-204ng/mL)				230.6
cortisol (4-22mcg/dL)				37.1
thyroid-stimulating hormone, TSH (0.3-5.0mcIU/mL)				0.9
thyroxine, T4 free (0.7-1.8ng/dL)				1.46
glucose (60-99mg/dL)					97		99
Arterial blood gas analysis
pH (7.35-7.45)				7.3	7.40	7.53
PCO₂ (35-45mmHg)				35	30	30
PO₂ (80-105mmHg)				171	158	178
SO₂ (94-100%)				99	99	100
HCO₃ (22-26mmol/L)				17.2	18.6	25.1
Base excess (-2 a +2mmol/L)				-9.2	-6.2	2.4
Renal function (*ref)
urea (15-50mg/dL)		5	7	7	8	10	11
creatinine (0.5-1.3mg/dL)		0.4	0.4	0.3	0.6	0.3	0.3
plasmatic osmolality (275-295mOsm/Kg H₂O)		268	264.5	232.5	292.7	291	301
Urine test, 10mL random sample
aspect				Clear
glucose (mg/dL)				250
bilirubin				Negative
ketone				Negative
density (1,000-1,030)				1010
Hemoglobin				Positive
pH (5.0-9.0)				5.0
protein (mg/dL)				100
urobilinogen				Normal
Nitrites				Negative
sodium (20mEq/L)				64
potassium (15mEq/L)				43
creatinine (20-230mg/dL)				82.4
urea (350-1,000mg/dL)				364
urine osmolality (50-1,200 mOsm/Kg H₂O)				280.11
Cerebrospinal fluid
cells (0-4/mm³)				7,0
proteins (10-28mg/dL)				24
relation albumin/globulin				1.61
glucose (40-70mg/dL)				68
chlorate (680-750mg/dL)				700
reactions of Pandy, Nonne and Takata-Ara				Negatives
direct examination - China Ink				Negative
reaction of VDRL				Non-reagent
fungal antigens testing (CRYTO-LA-TEST)				Non-reagent
Serology
neurosyphilis (Wasserman, FTA-ABS, Hemagglutination)				Non-reagent
cisticercose (Weinberg test; Immunofluorescence, ELISA)				Non-reagent
toxoplasmosis (Immunofluorescence)				Non-reagent
toxoplasmosis (Hemagglutination)				Reagent (1/4)
cytomegalovirus (IgM and IgG, ELISA)				Non-reagent
herpes simplex 1 and 2 (IgM and IgG, ELISA)				Non-reagent
herpes zoster (IgM and IgG, ELISA)				Non-reagent
human T- lymphotropic virus type 1 and 2 (ELISA)				Non-reagent
human immunodeficiency virus type 1 and 2 (ELISA)				Non-reagent
dengue (IgM ELISA)				Non-reagent

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[1] Corresponding author: Dr. Carlos Alexandre Antunes de Brito. e-mail: cbritoc@gmail.com