Expanded dengue syndrome with small-medium-vessel vasculitis: A case report.

Area of Science:

• Infectious Diseases
• Vascular Medicine
• Dermatology

Background:

• Expanded Dengue Syndrome (EDS) encompasses atypical clinical presentations of dengue virus infection, with new manifestations reported annually.
• While dengue myocarditis is documented, severe vasculitis is a rare complication.

Observation:

• A 38-year-old male presented with prolonged fever, myalgia, headache, and progressive purpura on lower limbs.
• He developed breathlessness, toe gangrene, and was diagnosed with cutaneous small-vessel vasculitis, myocarditis, and possible hemolytic anemia.
• Infectious workup was negative except for positive dengue serology (ELISA-IgM).

Findings:

• The patient exhibited widespread endothelial activation, leading to both small-vessel vasculitis (purpura) and medium-vessel vasculitis (gangrene).
• Myocarditis and pulmonary edema contributed to respiratory distress, evidenced by elevated NT-pro-BNP.
• Hemolytic anemia secondary to microangiopathy was also suspected.

Implications:

• This case underscores the potential for dengue virus to cause extensive vascular damage and severe atypical presentations.
• It emphasizes the importance of considering dengue in endemic areas, even with unusual symptoms.
• Further research into the mechanisms of dengue-induced vasculitis is warranted.