Levodopa-induced dyskinesia triggered by acute dengue fever in a case of Parkinson’s disease

Dengue fever causes morbidity and mortality in tropical and subtropical areas. Dengue fever has been associated with a variety of neurological symptoms, including encephalopathy, Guillain-Barre Syndrome (GBS), acute disseminated encephalomyelitis, acute transverse myelitis, cranial nerve palsies, parkinsonism, and myositis. [1] However, parkinsonism-induced dyskinesia triggered by dengue infection has not been reported so far. Levodopa is the preferred drug for treating Parkinson’s disease (PD). Despite the negative effects of abnormal involuntary movements such as dyskinesia, levodopa is the most effectively used drug for the treatment of motor control in patients with PD. We present the case of a 65-year-old male, diagnosed with PD 1 year back and on levodopa therapy, who presented with severe dyskinesia after an episode of acute febrile illness. Investigations revealed positive dengue serology. Drug titration was performed along with supportive treatment for fever. The patient completely recovered from dyskinesia after the fever subsided. This case report emphasizes the importance of infection precipitating dyskinesia early on, in a stable PD patient on levodopa therapy.