Atypical presentation of dengue fever with unilateral massive hemothorax: A case report

Dengue fever is a mosquito-transmitted fever, resulting from infection by an RNA virus. Each year, almost 100–400 million new cases of dengue are reported across the globe, with 25 % of them producing symptoms. WHO 2009 classification categorizes dengue into three groups: dengue without warning signs (mild symptoms without plasma leakage), dengue with warning signs (mucosal bleeding, rising hematocrit and thrombocytopenia), and severe dengue (severe bleeding, shock or organ impairment). Although in most cases, it presents with fever, body aches and a maculopapular rash (typical presentation), atypical manifestation of this condition can also be rarely encountered. Here, we present a case of a 20-year-old male, who demonstrated an atypical presentation of dengue fever, confirmed by positive IgM serology. He had developed progressive shortness of breath, in addition to fever and body pains. Later, chest x-ray and thoracentesis revealed a massive hemothorax. He was managed with tube thoracostomy and intravenous fluids, which lead to a gradual improvement of his condition. Through this case, we highlight the significance of early recognition of the atypical presentations of dengue fever.