Unusual manifestations of dengue: a case series

Abstract

Dengue fever ranges from asymptomatic infection to dengue shock syndrome. However, there are patients presenting with atypical symptoms, as highlighted in this case series. A 27-year-old male presented with clinical features suggestive of appendicitis and a positive dengue NS1 antigen test. However, the ultrasound scan revealed a normal appendix. This case highlights the possibility of dengue fever presenting with atypical abdominal signs which pose a significant diagnostic challenge. A 57-year-old female presented with one day history of fever and a positive dengue NS1 antigen test. Ultrasound scan revealed evidence of significant leaking on day one of fever; which is unusual as leaking usually occurs at three to seven days of fever. This highlights the importance of screening for fluid leakage from the initial presentation. A 35-year-old female presented with a seven days history of fever. On the day eight of fever, an ultrasound scan showed significant leaking. Her dengue NS1 antigen test was positive, but dengue IgM antibodies were not detected. This is very unusual considering the classic serological progression of the disease. Furthermore, this patient showed evidence of leaking, whilst having a positive NS1 antigen test, which is very unusual. A 59-year-old female presented with fever for four days and became irritable, somnolent and aggressive; but there was no clinical evidence of meningitis. She had a positive dengue IgM antibody test. An electroencephalogram, revealed an encephalopathy. However, CSF analysis was not performed due to profound thrombocytopenia, making it difficult to exclude any other encephalitic pathogens. Such atypical manifestations described above might be unrecognized and underreported. So, every clinician needs to have a high index of suspicion, or else these uncommon manifestations of a common disease could be easily missed, leading to devastating consequences.