Urine analysis showed a pH of 6 with normal specific gravity and no proteinuria sellekchem or glycosuria, and spot urinary sodium potassium and calcium were within normal limits, the hospital stay was uneventful. After 7 days, a challenge test performed with heavy carbohydrates diet and strenuous exercise, followed by rest, failed to produce any weakness. For the challenge test, the patient was hospitalized, and the procedure was explained to him. An informed consent was obtained. It was undertaken in an intensive care setting. His nerve conduction velocity (NCV)/electromyography (EMG) was completely normal, ECG showed prominent U waves [Figure 1], his dengue NS1 antigen ELISA[2] as well as dengue IgM antibody test were positive.

A diagnosis of dengue fever with thrombocytopenia with hypokalemic motor paralysis was made and the patient was given intravenous potassium chloride infusion. His motor power improved rapidly and at 10 h of starting treatment his power was completely normal. On the second day of treatment, his repeat serum potassium was 3.9 meq/l. The patient was not given any treatment for thrombocytopenia and was kept under observation as no signs of bleeding diathesis were present. At the end of first week, his platelet count became completely normal. The patient was discharged on 5th day of admission with advice for follow-up. Figure 1 (a) ECG at the time of presentation, At the time of presentation when serum potassium is 1.82 mmol.l, Electrocardiogram revealed heart rate of 75/min with prolongation of PR interval, ST segment depression, T wave inversion and prominent U wave typical .

.. DISCUSSION Dengue was regarded as a nonneurotropic virus. There are however recent reports on neurotropism or neuroinvasion of dengue virus infection.[2,3] The syndrome of acute pure motor weakness in dengue was quite characteristic and has not been comprehensively evaluated in earlier reports. The clinical picture simulated Guillain�CBarre (GB) syndrome. The presence of fever at the time of weakness, normal nerve conduction studies and the absence of albumin cytological dissociation and response with potassium supplement excluded the possibility of GB syndrome.[2] Familial periodic paralysis was unlikely because there was no family history of episodic motor weakness and this being their first episode.

The pathology of neurological manifestation is multiple and includes neurotropic effect of dengue virus, systemic effect of dengue infection, and immune-mediated injury.[4] Jha and Ansari[5] reported three confirmed cases of dengue infection causing acute reversible-hypokalemic pure motor quadriparesis. Gupta et al.[1] reported two confirmed cases of hypokalemic periodic Dacomitinib paralysis precipitated by upper respiratory tract infection of viral etiology. They also observed that potassium supplementation resulted in rapid improvement of symptoms. Santos et al.[6] reported GB syndrome in the course of dengue.