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This case highlights the need for early recognition of severe dengue to prevent progression to critical complications.

May 20, 2026American Journal of Respiratory and Critical Care Medicine0 citations

C48-31 Severe Dengue Shock Syndrome in an Endemic Region: A Case Emphasizing Early Recognition

GSG O SalgadoSan Juan City Hospital BLB LopezSan Juan City Hospital MGM GinesSan Juan City Hospital

Key Points

This case highlights the need for early recognition of severe dengue to prevent progression to critical complications.
Reported a case of a young Latina with presenting symptoms of malaise and weakness, later evaluated for severe dengue.
Utilized laboratory evaluations including arterial blood gases and imaging to assess severity and complications.
Considered diagnostic challenges related to geographic and demographic disparities in recognition of dengue.
Patient presented with hypotension, tachycardia, leukopenia, anemia, and thrombocytopenia indicative of severe dengue.
CT scan revealed significant abdominal edema and signs of systemic capillary leak leading to ARDS.
Emphasized the importance of recognizing specific triad features to avoid misdiagnosis and complications.

Abstract

Abstract Background In dengue-endemic regions, early presentations are often mislabeled as mild viral illness or dehydration, delaying recognition of severe disease. These diagnostic blind spots disproportionately impact Latina and Hispanic patients when local epidemiology is underweighted. Severe dengue requires high clinical suspicion to prevent rapid progression to shock, ARDS, and multiorgan failure. Case Presentation A previously healthy young Latina presented twice within 24 hours for malaise, nausea, and generalized weakness. On re-evaluation, she was hypotensive and tachycardic with marked dryness and respiratory distress. Laboratory evaluation revealed leukopenia, anemia, and thrombocytopenia. Arterial blood gas demonstrated acidemia with hypoxemia. She was admitted to the medical ICU with suspected severe dengue and septic shock. CT abdomen revealed periportal and gallbladder wall edema, renal hypoperfusion, pancolitis, and mild peritonitis—radiologic indicators of systemic capillary leak. Despite cautious fluid titration, vasopressors, and antimicrobial coverage, she progressed to diffuse pulmonary crackles, petechiae, and ARDS. Serology confirmed dengue virus infection. Discussion Early clinical subtlety should never obscure the potential for catastrophic arboviral sepsis. In dengue-endemic areas, concurrent cytopenias, metabolic acidosis with hypoxemia, and imaging features of third spacing demand urgent consideration of severe dengue. Over-resuscitation can worsen plasma leakage and pulmonary edema; thus, vasopressor-driven hemodynamic support and early critical-care activation are essential. Diagnostic delay may be compounded by implicit bias and limited integration of endemic disease patterns into initial triage reasoning. Conclusion Recognizing the hallmark triad of cytopenias, metabolic acidosis with hypoxemia, and radiologic third spacing can narrow diagnostic blind spots and prevent progression to ARDS and multiorgan failure. Integrating endemic epidemiology into clinical reasoning is essential not only for timely, evidence-based care—but also for advancing health equity. This abstract is funded by: None

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