A 56‐year‐old man presented to our emergency department with a 4‐day history of fevers, myalgias, nausea, vomiting, and diarrhea. He had recently returned from a trip to Mumbai, India for which he had not taken any malaria prophylaxis nor did he receive any vaccinations. He reported drinking bottled water except on one occasion when he drank water from an unlabeled cooler. Physical exam was relatively unremarkable except for mild diffuse abdominal tenderness. His initial workup was remarkable for thrombocytopenia, leukopenia, mild transaminitis, and a positive influenza B. antigen. His chest x‐ray showed no abnormality. He was started on oseltamavir and admitted for symptom management as well as IV fluid hydration. Three malaria blood preps were negative. Stool cultures, Clostridium difficile assay, CMV, and EBV studies were negative for acute infection. Viral hepatitis serologies were negative for infection and a right upper quadrant ultrasound was unremarkable. Dengue serology was drawn. During his hospital stay, his WBC and platelet counts declined to troughs of 1.9 and 19,000, respectively. After 5 days of supportive care, his symptoms improved, and he was able to tolerate a full diet. He remained afebrile and hemodynamically stable throughout his hospitalization. His dengue IgM titer returned after discharge and was elevated at 8.02 (reference < 0.90). His transaminitis, leukopenia, and thrombocytopenia returned to normal a week after discharge.
Dengue fever is caused by an RNA virus, endemic to tropical areas, transmitted by the Aedes aegypti mosquito. Our case describes the presentation of a patient with influenza and a concurrent dengue infection. Through a detailed history, we were able to assess our patient's risk for alternate etiologies for his symptoms other than just influenza. A careful history is important because dengue has a wide range of presentations. The diagnosis is most often made clinically on the basis of reported symptoms and physical exam and should be entertained in any patient who develops a fever within two weeks of being in an endemic area. The diagnosis is confirmed via viral cultures, viral RNA PCR, or identification of specific IgM antibodies. In most cases the management of dengue is supportive as there are currently no antiviral medications or approved vaccines for this virus. In rare cases patients can develop dengue shock syndrome or dengue hemorrhagic fever. Understanding the presentation and potential severe complications of dengue will allow physicians to identify as well as appropriately monitor these patients.
Hospitalists often care for patients with travel‐associated illness. A thorough history, including dates of travel and exposure, is critical to arriving at a correct diagnosis.
To cite this abstract:Kanuru R, Matcheswalla S. Dengue Fever: A History‐Taking Lesson. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 492. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/dengue-fever-a-historytaking-lesson/. Accessed May 26, 2019.