Fatal subarachnoidal haemorrhage in a Norwegian traveller with dengue virus infection

We present a Norwegian female in her thirties who acquired dengue fever caused by dengue virus serotype 2 while travelling to Mexico. When hospitalised 3 days after symptom onset, the patient had severe headache, fever, rash and a positive tourniquet test, but did not fulfil the criteria of dengue haemorrhagic fever (DHF). Five days later she developed a fatal subarachnoidal haemorrhage. A post-mortem examination failed to reveal any intracranial arterial aneurysm. Our case was consistent with so called 'dengue fever with haemorrhages', a recently described entity that mainly affects adults and may cause severe bleedings also in the absence of DHF.