Dengue fever complicated by spontaneous intracranial and intraspinal hemorrhage: A case report

Minor petechial hemorrhages with dengue fever are common due to thrombocytopenia. We report a case of dengue fever complicated by intracranial and intraspinal hemorrhage. A 73-year-old male with dengue fever developed seizure and encephalopathy. The initial MRI of the brain was normal. He had a further drop in platelet counts, and measures to raise platelet counts were taken. An MRI was repeated after one week, which revealed subarachnoid hemorrhage (SAH), intraparenchymal hemorrhage, and intraventricular hemorrhage in the brain and intraspinal SAH with intradural hematoma compressing the thoracic spinal cord. A continuous lumbar drain was placed after correcting the platelet levels. Follow-up imaging showed resolution of SAH and parenchymal bleed. Dengue hemorrhagic fever can be further complicated by spontaneous intracranial or intraspinal hemorrhage. Worsening of the neurological condition should alert clinicians to be highly suspicious of this extremely rare complication of dengue fever.