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Lateral rectus paralysis: An emerging neuro-ophthalmic manifestation in dengue fever

The purpose of presenting this case study is to find out the possible etiopathogenesis of lateral rectus (LR) palsy. A 17-year-old female patient presented with acute vomiting, diplopia, and bleeding per vagina for 3 days after 10 days of persistent fever. Restricted ocular movements in the right field of gaze suggested right LR paralysis, although diplopia charting performed by red and green glasses showed inconsistent results. Dilated fundoscopy examination revealed asymmetrical early papilledema. Reduced serum sodium levels less than 130 mEq/l with positive enzyme-linked immunosorbent assay NS1 antigen were found. Management included administration of intravenous fluids, inotropes, 20% mannitol, and 4 units of donor platelet transfusion. Symptomatic improvement with complete remission of diplopia was observed. This is the first case study that revealed the transient course of dengue-induced LR paralysis, the pathophysiology of which may possibly due to reduced serum sodium levels and/or raised intracranial pressure (ICP). The pathophysiology of raised ICP in dengue fever merits further research.