A 62 year old female with no past medical history presented to the ED with fevers, generalized weakness, severe muscle aches, and a rash. She had returned home from the Philippines 3 days prior to evaluation. Twenty-four hours prior to arrival, the patient noticed a rash on her shins. She denied any nausea, vomiting, diarrhea, abdominal pain, chest pain, shortness of breath, cough, sore throat, dysuria, urinary frequency, headache, and neck pain. The patient was in the Philippines for a family funeral and was indoors for most of the trip. She was unsure if she was stung by any bugs or mosquitos.
Dengue fever can be difficult to identify as its presentation overlaps with several other infectious diseases including typhoid fever, West Nile virus, malaria, and leptospirosis.
Dengue fever is identified clinically by the presence of fever and 2 or more of the following in a febrile person who traveled to or lives in a dengue-endemic area:
Retro-orbital or ocular pain
Myalgia and/or bone pain
Hemorrhagic manifestations (including petechiae)
The diagnosis can be confirmed with serologies or nucleic acid amplification tests.
Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2019 SAEM Annual Meeting | Copyrighted by SAEM 2019 – all rights reserved. View other other cases from this series on ALiEM.