This review systematically analyzes dengue-associated transverse myelitis case reports to summarize their clinical presentation and outcomes.

Dengue-associated transverse myelitis (DATM) is a rare but severe complication of dengue, a re-emerging arboviral disease widespread in the Americas and Asia, with high risk of long-term disability. Its immunopathological mechanisms are poorly understood, and the epidemiological burden remains unknown.

We searched PubMed, Scopus, Web of Science and Embase through May 2025 following PRISMA guidelines. Case reports of DATM in confirmed dengue infection were included without restrictions. We extracted data on demographics, diagnostics, serotype, clinical presentation, complications, and outcomes. Study heterogeneity and publication bias were noted.

A total of 29 DATM cases were identified; cases were reported mainly from India (n=11, 37.9%), Brazil (n=4, 13.8%), Pakistan (n=3, 10.3%), and Singapore (n= 3, 10.3%). Most patients were male (n=18, 62.1%), with a mean age of 36.1 ± 17.6 years. Diagnosis was confirmed primarily through IgM serology (55.2%) and NS1 antigen testing (34.5%), with serotyping reported in only 10.3% of cases (mostly DENV-2; 66.7%). Neurological symptoms began 8.3 ± 6.5 days after dengue onset.

The most common initial neurological manifestations were urinary retention (72.4%) and bilateral lower limb weakness (58.6%). Complications were reported in 9 cases, including respiratory failure (33.3%), neurogenic shock (11.1%), and subarachnoid hemorrhage (11.1%). One patient did not survive, and four required ICU admission. Neurological outcomes were heterogeneous: some achieved complete recovery within 2 weeks to 6 months, while others had persistent deficits in motor, sensory, and/or sphincter function. Only one remained paraplegic; another had moderate long-term functional limitations.

DATM, though rare, should be considered in the differential diagnosis of acute myelitis in endemic regions and returning travelers. Early recognition is essential, as prompt intervention can improve outcomes. Strengthening epidemiological surveillance and conducting translational research will clarify immunopathological mechanisms and guide targeted therapies.