Clinical characteristics and outcomes of dengue-associated transverse myelitis: A systematic review of case reports

Dengue is a globally prevalent arboviral infection with an expanding spectrum of recognized neurological complications. Dengue-associated transverse myelitis (DATM) is a rare but potentially disabling manifestation, and its clinical characteristics and outcomes have not been systematically synthesized.

Characterize the level and extent of spinal cord involvement, clinical presentation, management, and outcomes of DATM.

A systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, Embase (Ovid), and Web of Science were searched from inception through October 2025. Case reports describing transverse myelitis in patients with confirmed dengue infection were included. Data were extracted and synthesized descriptively. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Checklist for Case Reports.

Twenty-nine case reports met inclusion criteria. The median age was 38 (IQR 20) years, with male predominance (62.1%). Neurological symptoms developed a median of 6 (IQR 4) days after dengue onset. Urinary retention (79.3%) and paraparesis (69.0%) were the most common presenting features, and a thoracic sensory level was frequently identified (65.5%). Spinal MRI most often demonstrated longitudinally extensive transverse myelitis (65.5%). Corticosteroids were administered in 82.8% of cases. At discharge, 69% had partial recovery and 17.2% complete recovery. Mortality was low (3.4%; one case).

DATM is a rare, early-onset neurological complication of dengue characterized by urinary retention, paraparesis, and frequent thoracic cord involvement, often with longitudinally extensive lesions on MRI. Although most patients experience partial or complete recovery, residual deficits may occur. Evidence is limited to case reports, precluding estimation of incidence or comparative treatment efficacy. Early recognition and exclusion of alternative causes of acute myelopathy are essential.