Dengue Fever: Two Unexpected Findings

Further, regarding the patient in the second case, though proteinuria, hematuria, acute renal failure, and glomerulonephritis are previously described renal complications of dengue,⁹ a thorough literature search yielded no prior published accounts of renal infarction. Given the patient’s previous healthy status and the lack of other hypothesis as to the mechanism of injury, we suspect this patient’s renal infarction was due to the transient hypercoagulability characteristic of dengue and responsible for other clinical manifestations of the disease.

Conclusion

In addition to more prevalent illnesses such as malaria, acute traveler’s diarrhea, and respiratory tract infections, dengue fever should be included in the differential diagnosis when evaluating a febrile patient who has a history of recent travel to countries where dengue is endemic. A high clinical suspicion, combined with a thorough history and physical examination, is essential to making the diagnosis.

Both of our case reports demonstrate some of the diagnostic limitations in the acute setting, and the breadth of clinical complications that can occur in this complex disease. With the increasing prevalence of dengue fever in North and Central America, it is likely that patients with the disease will present to EDs in the United States. Early diagnosis and awareness of potential complications can lead to timely initiation of life-saving supportive care.