Case of dengue fever with rare manifestations in a 32-year-old male with no significant medical history.
This article describes rare manifestations of dengue fever in a 32-year-old male patient. He presented to the emergency room with an 8-day history of fever, bilateral subconjunctival hemorrhages, a 3-day history of swelling of hands and lips and 1 episode of nasal bleeding.
Examination showed continuous high grade fever with associated rigors/chills and generalised body ache. The patient developed bilateral conjunctival hemmorrhages in the absence of trauma. Examination further revealed visibly swollen hands and feet. The swelling had progressed over 3 days. In addition, he also had a single episode of 1-2 teaspoons of nasal bleeding. He also had a tingling sensation in both his lower limbs that made it difficult for him to walk. He did not have a history of bleeding from any other parts of the body. Nor did he complain of any vomiting. He had no past hospitalisations and did not take any drugs or abuse a substance. He belonged to a middle class background, married and sexually active. His family’s medical history did not reveal anything significant.
Diagnosis and treatment
The patient was diagnosed with dengue fever which is a common cause of arthropod-borne viral disease. Symptoms include, high fever, headache, rash, myalgia and arthralgia. The illness is self-limiting. In some cases dengue can result in hemorrhagic fever and dengue shock syndrome. The patient’s investigations were consistent with dengue fever. He had also developed a systemic fungal infection secondary to Candida tropicalis infection. In addition, bone marrow biopsy showed hemophagocytic activity. He had also developed Hepatitis E infection. CT showed bilateral iliopsoas hematoma which manifested as decreased power in bilateral lower limbs and pain in the right leg.
He was administered antibiotics (ceftriaxone 2 g once daily for 14 days) and antifungal (fluconazole 200 mg per oral initially for one day then 100 mg daily for 13 days). He showed significant improvement before being discharged. Dengue can present variably in different patients, making the diagnosis challenging, as in this case.
References
A Curious Case of Dengue Fever: A Case Report of Unorthodox Manifestations https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399777/
