# Atypical manifestations of Dengue fever: case series in tertiary care hospital in Nepal

## TL;DR

This case series from Nepal highlights unusual dengue fever complications, showing the importance of imaging for early detection and treatment.

## Contribution

The study reports atypical imaging findings in dengue patients, including neurological and hemorrhagic complications.

## Key findings

- Imaging revealed psoas hematoma, pulmonary hemorrhage, and multifocal pneumonia in dengue patients.
- Neurological complications like meningoencephalitis and hemorrhagic stroke were observed in some cases.
- Early imaging helped detect unusual dengue complications, aiding prompt treatment and recovery.

## Abstract

Dengue fever is common in Southeast Asia, including Nepal, caused by the Flavi virus transmitted through mosquito bites of Aedes aegypti species. Symptoms include high-grade fever, skin rash, headache and arthralgia, with a low case fatality rate of less than 1%. Severe forms are characterized by low platelet count, vascular leakage, and low blood pressure, often leading to life-threatening complications. Common imaging findings include gall bladder wall thickening, hepatosplenomegaly, ascites, pericardial effusion, and pleural effusion. Dengue was initially considered non-neurotropic, but recent studies suggest that the virus can invade the central nervous system, indicating its neurotropic potential presenting with encephalitis and meningitis. In this case series, we have described atypical imaging findings of 7 patients in patients with laboratory confirmed dengue fever, which revealed imaging features of psoas hematoma in 1 case, diffuse pulmonary haemorrhage in 1 case, multifocal pneumonia in 1 case, hemorrhagic stroke with venous thrombosis in 1 case, dengue meningoencephalitis in 2 cases and dengue encephalitis with Cytotoxic lesion of the corpus callosum in 1 case. This case series emphasizes the important role of imaging findings in severe dengue patients with suspicion of unusual complications as early detection and prompt treatment are crucial for recovery and to prevent fatal complications.