An interesting case of Parkinsonism in the young

A 16-year-old female with no prior comorbidities came with chief complaints of fever and headache for 4 days associated with altered sensorium for the past 15 days in the form of decreased responsiveness. On general physical examination, Glasgow Coma Scale score was 6 with E1V1M4. Vitals were stable. Central nervous system examination revealed that bilateral pupils were sluggishly reactive to light. All extremities were rigid. A provisional diagnosis of viral encephalitis was made and was empirically started on acyclovir, doxycycline, ceftriaxone and vancomycin. Cerebrospinal fluid (CSF) showed lymphocytic pleocytosis, elevated proteins and normal glucose. CSF pan-neurotropic virus panel was negative. Serological testing for immunoglobulin M (IgM) against Japanese encephalitis virus positive. Magnetic resonance imaging of the brain showed symmetrical T2 hyperintense areas in the bilateral basal ganglia, thalamus and splenium of corpus callosum. The patient was started on oral levodopa plus carbidopa; sensorium became better and Parkinsonian features improved gradually.