Japanese Encephalitis: a case of remarkable recovery after 68 days of ICU admission in a 30 -years-old-male.

introduction and importanceJapanese Encephalitis is a disease of central nervous system caused by Japanese Encephalitis Virus (JEV), a flavi virus transmitted by culex mosquitoes. Only < 1% of the infected people develop symptoms and among symptomatic cases, around 1/3rd die and remaining 30–50% develop persisted neurological damage. Here, we present an unusual case of 30 years male with severe neurological manifestations requiring intubation and ICU admission for 68 days but miraculously recovering completely without any residual neurological deficits. CASE PRESENTATION: We present a case of 30 years Male who presented with high grade fever, headache, vomiting which progressed to altered sensorium and decreased GCS requiring intubation. CNS infection was suspected based on presentation and diagnosis of JE was confirmed with CSF anti-JEV IgM ELISA however CNS imaging was not significant. He was managed in ICU for 68 days with supportive care, antibiotics for ventilator associated pneumonia and physiotherapy. On long term follow up on outpatient basis, he unexpectedly recovered fully with no neurological deficits despite severe manifestations on initial presentation. DISCUSSION: Japanese Encephalitis, a disease of the CNS, is often asymptomatic, but once a patient becomes symptomatic, it has very bad prognosis with high morbidity and mortality and many patients end up developing lifelong neurological deficits. Our case says otherwise, in which our patient undergoes complete recovery despite severe manifestations on initial presentation. Although this is not the only reported case of recovery from Japanese Encephalitis with severe manifestations at presentation, complete recovery is very rare and this case emphasizes on favorable factors and timely intervention that can help reduce morbidity and mortality in similar cases in the future.

conclusionThis case presents an unusual outcome of JE. Although the prognosis of JE isn’t great, from this case we can say that despite severe presentation we can have favorable outcomes with supportive care and long-term physiotherapy. It’ll also be helpful while counseling the patient and patient parties on the prognosis of JE. Further research is required to update the outcomes in JE patients in current healthcare settings.