Beyond the Classic: Atypical Dengue Presentations

Dengue is an arthropod-borne viral infection caused by the dengue virus and spread by the vector Aedes mosquitoes. The clinical spectrum of dengue includes undifferentiated fever, dengue fever, dengue hemorrhagic fever, dengue shock syndrome, and expanded dengue syndrome (EDS). The patients may present with atypical symptoms and involve organs like the liver, kidney, brain, heart, bone marrow, and central nervous system. Three atypical dengue cases belonging to the EDS that had presented to the Emergency Department of a tertiary care center in Kerala, South India, are described in the case series. The first patient developed hemophagocytic lymphohistiocytosis secondary to dengue infection. The second patient had presented with altered mental status and was diagnosed with dengue encephalitis. The third patient had hyponatremia-syndrome of inappropriate anti-diuretic hormone secretion along with dengue infection. With a rapid increase in dengue cases worldwide, atypical presentations of dengue are no longer uncommon. Timely recognition and prompt management of the atypical presentation are needed, as many of the manifestations have serious outcomes. Hence, clinicians should be aware of the atypical manifestations of dengue.