[A Case of Dengue Fever Presenting with Fever and Atypical Skin Rash and A Literature Review]

The Dengue virus (DENV) is an arthropod-borne flavivirus that causes Dengue fever. While it is frequently seen in tropical and subtropical regions such as the Americas, Southeast Asia, Africa, the Eastern Mediterranean and Western Pacific countries, it has been observed to spread to wider geographical areas in recent years. Dengue fever is currently the most widespread mosquito-borne infection worldwide. In our country, the reported cases are imported cases with a history of travel to these regions. However, factors such as the presence of Aedes mosquitoes in our geography, global climate change and increasing international travel suggest that these mosquitoes could become infected with the virus and potentially cause outbreaks in the future. Following mosquito exposure, the incubation period is typically three to seven days, and the disease usually presents with fever and rash. It has a broad clinical spectrum ranging from asymptomatic infection to hemorrhagic syndromes, shock, and even death. Diagnostic methods include nucleic acid detection by real-time polymerase chain reaction (RT-PCR), detection of non-structural protein 1 (NS1) antigen, and serological testing for IgM and IgG antibodies. This report presents a case of imported dengue fever that developed after the patient returned to our country from Costa Rica. A 39-year-old female patient presented to our outpatient clinic with complaints of fever, myalgia, fatigue, and rash on the legs, which began two days after her return to the country. Additional symptoms included sore throat, dry cough, loss of appetite, and diarrhea. Physical examination revealed fever and prominent maculopapular rash on the feet. She was admitted to our inpatient unit for close clinical monitoring and supportive care. Her laboratory tests showed leukopenia (3500/μL), lymphopenia (700/μL), and an elevated C-reactive protein (14 mg/L). The DENV-PCR test conducted by the National Arbovirus and Viral Zoonotic Diseases Laboratory of the General Directorate of Public Health was found to be positive. Dengue IgG and IgM antibodies tested by the immunofluorescent antibody method were also positive. The patient was hospitalized for the first five days and subsequently followed up on an outpatient basis. During the follow-up, complete recovery of clinical symptoms and laboratory findings was observed. This case report and literature review emphasized the importance of travel-related infections and the consideration of Dengue fever in the differential diagnosis of these infections.