The Many Faces of Dengue Infection: Dengue Infection Masquerading as Acute Airway Edema

Acute supraglottic edema is an uncommon but potentially fatal cause of upper-airway obstruction. Although dengue infection is associated with diverse systemic manifestations, isolated upper-airway involvement is exceedingly rare and may pose a significant diagnostic challenge. We report an elderly woman who initially presented with features of acute stroke but was subsequently found to have life-threatening airway edema as a manifestation of acute dengue infection. Neuroimaging excluded acute cerebrovascular disease. Within six hours, she rapidly developed inspiratory stridor, hypoxemia, and hypercapnic respiratory failure requiring emergency endotracheal intubation. Flexible fiberoptic laryngoscopy demonstrated diffuse supraglottic and laryngopharyngeal edema, leading to compromised airway. Initial blood investigations revealed thrombocytopenia and a positive dengue NS1 antigen (sent in view of the ongoing dengue endemic), establishing the diagnosis of acute dengue infection. Conservative management comprising mechanical ventilation, corticosteroids, antibiotics, electrolyte correction, and serial fiberoptic airway assessment resulted in complete recovery without tracheostomy. This case highlights the evolving diversity of presenting clinical features associated with dengue infections. The pathophysiology of isolated airway edema in dengue is quite unknown and is beyond the scope of this article, but prompt pharmacological management, along with airway protection, reflects the reversible nature of this symptom and the likelihood of an underlying non-IgE-mediated hypersensitivity-related pathophysiological process. Early recognition of evolving airway compromise and prompt multidisciplinary intervention are essential for favorable outcomes.