Cute necrotising encephalitis - An unusual presentation of Dengue viral infection

Dengue virus infection has an unpredictable clinical course ranging from a short febrile illness to Dengue hemorrhagic fever presenting with shock. While encephalitis secondary to Dengue infection is not uncommon, here we report a case of Dengue encephalitis manifesting with acute necrotising encephalitis in a 12 year old girl who presented with history of fever, seizures and altered consciousness for a short duration. She subsequently developed worsening of sensorium, haemoconcentration and thrombocytopenia with features of thalamic dysfunction and autonomic instability. Dengue infection was confirmed by serology. MRI was suggestive of acute necrotising encephalitis. A high degree of suspicion needs be kept for this complication in any child presenting with Dengue encephalitis with unexpected clinical manifestations.