A 14-year-old girl was brought to the emergency department with a history of fever for five days, two episodes of seizures, followed by altered sensorium of one day’s duration. She was febrile, stuporous with a Glasgow Coma scale score of 10 and with terminal neck stiffness. Possibility of meningoencephalitis was considered and was started on intravenous levetiracetam and ceftriaxone. A hemogram revealed hemoglobin of 12 g/ dl, total leukocyte count 3500/mm3, platelet count of 76,000/ mm3. Other laboratory parameters were random blood sugar of 86 mg/dl, and serum creatinine 0.8 mg/dl. Serum electrolytes, calcium, magnesium, and liver function tests were within normal limits. Serum dengue immunoglobulin (Ig)-M was strongly positive. Evaluation for differentials including Japanese encephalitis, leptospira, scrub typhus, and malaria was negative.
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