Dengue hemorrhagic shock in the western hemisphere

A 39-year-old man after visiting an endemic dengue area during a local outbreak developed a febrile illness complicated by skin petechiae, bleeding, shock, hemoconcentration, and death. The presumptive diagnosis of dengue was made based on hemagglutination inhibition and complement fixation titers in a single sample. The serologic evidence and ancillary laboratory findings are compatible with a secondary antibody response.