Case Report: Severe Dengue Masquerading as Venous Thromboembolism; A rarepresentation of a Common Tropical Disease
Introduction
Dengue infection is a prevalent mosquito-borne viral infection. It is
recognized for its diverse clinical presentations, ranging from mild flu-like symptoms to
severe manifestations involving plasma leakage and multi-organ impairment.
Problem highlighted: dengue and venous thromboembolism
Case
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 myalgia, 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.
Conclusion
This adult patient with positive serology for dengue, severe
thrombocytopenia, and acute popliteal vein thrombosis became hemodynamic unstable
leading to subsequent death. To our knowledge, there are limited case reports of venous
thromboembolism (VTE) presenting in severe dengue.
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