# Diagnosis and Management of Dengue Fever in a Nonendemic Country: Lessons From an Acute Febrile Illness in Iran During the COVID-19 Outbreak

## TL;DR

A man in Iran who recently traveled to Indonesia was diagnosed with dengue fever, highlighting the need to consider nonendemic diseases in febrile illness diagnoses.

## Contribution

The paper emphasizes the diagnostic challenges of dengue fever in nonendemic regions during overlapping outbreaks like COVID-19.

## Key findings

- Dengue fever was confirmed in a patient through PCR and ELISA tests despite initial misdiagnoses.
- The patient's symptoms overlapped with those of COVID-19 and gastrointestinal infections, complicating diagnosis.
- The case underscores the importance of travel history and thorough diagnostic evaluation for febrile illnesses.

## Abstract

Dengue fever is a tropical arboviral disease that presents with a broad spectrum of clinical manifestations and can occasionally emerge in nonendemic regions due to factors such as international travel. This case report details a 47-year-old Iranian man who had recently returned from Jakarta, Indonesia, presenting with fever, diarrhea, vomiting, and myalgia during the COVID-19 outbreak. Despite initial misdiagnoses, dengue fever was confirmed through polymerase chain reaction (PCR) testing. Moreover, the serological analysis using enzyme-linked immunosorbent assay (ELISA) further demonstrated the presence of both IgM and IgG antibodies against the dengue virus. Initially, the patient's symptoms overlapped with COVID-19 and gastrointestinal infections, complicating the diagnosis. The management included supportive care, precautions against bleeding, fluid therapy, and empirical antibiotics due to suspected coinfections. This case highlights the importance of considering travel history and the possibility of nonendemic diseases in the differential diagnosis of febrile illnesses of unknown origin (FUO), particularly during concurrent outbreaks. Comprehensive history-taking and rigorous diagnostic evaluation are essential in such cases.