A Rare Case of Dengue Encephalitis with Atypical Neurological Presentation: A Case Report

Background: Dengue virus infection, though classically a self-limiting febrile illness, is increasingly recognized as a cause of neuroinvasive disease. Encephalitic presentations remain rare, under-reported, and diagnostically challenging, particularly at secondary-level healthcare facilities in endemic settings such as Bangladesh. Case Presentation: A 28-year-old woman from a rural catchment area of Paba, Rajshahi, presented to a secondary-level Upazila Health Complex with a five-day febrile illness followed by acute confusion, visual hallucinations, and focal motor seizures. On admission, her Glasgow Coma Scale (GCS) score was 11/15. Laboratory evaluation confirmed dengue infection (NS1 antigen positive; IgM positive, IgG negative) with thrombocytopenia (platelet count 45,000/µL, nadir 22,000/µL), leukopenia (3,100/µL), elevated hematocrit (44.5%), and transaminitis (AST 185 U/L, ALT 142 U/L). Plain CT of the brain performed at a local diagnostic center was unremarkable, and cerebrospinal fluid (CSF) analysis could not be performed locally. She was managed with isotonic intravenous fluids and intravenous levetiracetam, stabilized without inotropic support, and referred to a tertiary-care neurology/ICU facility. At one-month follow-up, she had achieved complete neurological recovery (GCS 15/15). Conclusion: This case underscores that dengue encephalitis can present with prominent psychiatric-type features — hallucinations and confusion — alongside seizures, even in the absence of early neuroimaging abnormalities. Clinicians at resource-limited secondary facilities should maintain a high index of suspicion for neuroinvasive dengue during febrile illness with atypical neurological signs and institute prompt anticonvulsant therapy and early referral pathways, which may favorably influence outcome.