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A Curious Case of Afebrile Dengue
Wasim Khot1, Nitin Gupta1, Saurav Khatiwada2
1Resident, Department of Medicine and Microbiology,AIIMS, New Delhi.
The Journal of the Association of Physicians of India
|July 21, 2019
Summary
This case study highlights afebrile dengue, a form of dengue without fever, which can present with severe symptoms like diabetic ketoacidosis, acute kidney injury, and pancytopenia in endemic regions.
Area of Science:
- Infectious Diseases
- Hematology
- Endocrinology
Background:
- Dengue fever is a significant public health concern in tropical and subtropical regions.
- Classic dengue presentation typically includes fever, rash, and myalgia.
- Atypical presentations of dengue can mimic other severe conditions, posing diagnostic challenges.
Observation:
- A 50-year-old male presented with DKA, successfully managed with hydration and insulin.
- Routine investigations revealed transaminitis, acute kidney injury, and pancytopenia.
- Diagnostic workup confirmed dengue infection via NS1 antigen and PCR, despite the absence of fever.
Findings:
- The patient exhibited DKA symptoms and laboratory abnormalities including liver dysfunction, kidney injury, and low blood counts.
- Dengue virus infection was confirmed through specific diagnostic assays.
- Crucially, the patient remained afebrile throughout the illness, with no reported history of fever.
Implications:
- This case underscores the potential for afebrile dengue presentations, challenging typical diagnostic paradigms.
- Clinicians in dengue-endemic areas should maintain a high index of suspicion for dengue even in the absence of fever, especially when patients present with multi-organ derangements.
- Recognizing atypical dengue presentations is vital for timely diagnosis and appropriate patient care, preventing potential complications.
