Case Report: Severe Dengue Masquerading as Venous Thromboembolism; A Rare Presentation of a Common Tropical Disease

Severe Dengue masquerading as Venous Thromboembolism; A rare presentation of a Common Tropical Disease. Dengue infection is a prevalent mosquito -borne viral infection 1 , recognized for its diverse clinical presentations, ranging from mild flu -like symptoms to severe manifestations involving plasma leakage and multi -organ impairment. 2 A 47 -year -old male with a recent diagnosis of Dengue and no prior history of coagulopathies or thrombotic disorders presented to the emergency room with complaints of swelling and pain in his right lower extremity. Three days before his presentation, he was seen in the ED for fevers, headaches, and myalgias, along with evidence of positive Dengue serology. He was diagnosed with dengue without warning signs and discharged with supportive care. Venous Doppler showed right popliteal vein thrombosis, and laboratory testing revealed thrombocytopenia (30 000 Thousands/uL), elevated LDH levels, and leukopenia 3600 thousands/uL. The patient was hospitalized for further evaluation. Four hours later, he had progressive shortness of breath with increasing oxygen requirements and undifferentiated shock requiring mechanical ventilation. He was started on Intravenous fluids, transfused Platelets vasopressors, and transferred to the intensive care unit. He remained in shock with a mean arterial pressure of 59 despite Norepinephrine 3mcg/kg. He was given boluses of both crystalloids and colloids; however, he remained in refractory shock. Despite aggressive management, the patient's clinical condition deteriorated, leading to multi -organ failure. Unfortunately, he succumbed hours after admission to the intensive care unit. Post Mortem revealed an occlusive thrombus in his pulmonary arteries. We present the case of an adult patient who presented hemodynamic instability, severe thrombocytopenia, and positive serology for dengue, in whom acute Popliteal Vein Thrombosis with embolization of deep vein thrombosis to PulmonaryEmbolism causing hemodynamic instability and subsequent death.To our knowledge, there are limited case reports of venous thromboembolism (VTE) presenting in severe dengue.