A Case of Japanese Encephalitis with Neuroendocrine Complication

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.