Dengue fever presenting with hepatitis

Dengue virus is one of the most common known causes of arboviral disease. Classic dengue fever (DF) is rarely fatal, but it may be incapacitating and require hospitalization. Atypical forms have been described involving the cardiac system, the central nervous system, and the hepatobiliary system. A 47-year-old white man returning from Ecuador presented with daily fevers, headaches, myalgias, vomiting, and no abnormal physical examination findings. His laboratory findings were notable for transaminitis and elevated DF convalescence titers. He was subsequently diagnosed with DF. This case is somewhat atypical because a literature search revealed no cases of transaminitis with classic DF in Central America with the same particular pattern as in this patient. Given the increase in global travel, an increase in DF with a wide range of organ involvement among those returning to the United States from endemic areas should be expected.