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.
General: Well-appearing
Skin: Petechial rash on bilateral shins
HEENT: Petechiae on hard and soft palate
Abdominal: Mild splenomegaly
CBC: WBC 3.1 x 10^9/L; Hgb 13.1 g/dL; Hct 38.5%; MCV 86.7; PLT- 14 x 10^9/L (Neutrophils 49%; Lymphocytes 31%; Monocytes 18%; Eosinophils 0%)
Morphology Smear: Unremarkable
BMP:
- Na 134 mmol/L
- K 3.1 mmol/L
- Cl 97 mmol/L
- CO2 26 mmol/L
- BUN 15 mg/dL
- Cr 0.65 mg/dL
- Ca 8.3 mmol/L
- Glucose 109 mg/dL
LFT:
- AST 117 U/L
- ALT 82 U/L
- ALK 100 U/L
- Bili 0.7 U/L
A petechial rash on bilateral shins and on the hard and soft palate.
Her laboratory values are remarkable for leukopenia and thrombocytopenia as well as transaminitis.
With her travel history, fevers, body aches, thrombocytopenia, and leukopenia, the patient’s presentation is most consistent with dengue fever.
Take Home Points
- 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:
- Headache
- Retro-orbital or ocular pain
- Myalgia and/or bone pain
- Arthralgia
- Rash
- Hemorrhagic manifestations (including petechiae)
- Leukopenia
- The diagnosis can be confirmed with serologies or nucleic acid amplification tests.
Brianna Miner, MD
Advocate Christ Medical Center
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