A Case Series of Dengue Fever with Unusual Presentation and Complications in a Rural Hospital.

Background: One of the most dangerous arboviral infections in the world is dengue. There are four significant serotypes for epidemiology. Dengue hemorrhagic fever (DHF) and dengue fever (DF) are the two clinical spectrums indicated by the classification. The majority of cases are stereotyped and take well to fluid resuscitation. Strange clinical manifestations, however, were frequently overlooked and led to mortality. Six of these dengue cases were treated in a rural tertiary care facility for a year, and after receiving problem-based curative therapy, all of the cases recovered fully.

Case description: During the midyear dengue epidemic in 2022, all six patients arrived at the rural tertiary care center located in southern India. There are two females and four males, with a mean age of 30 (range: 19-59). Three DHF, one DF, one dengue shock syndrome (DSS), and two original dengue infections were included in this investigation; most patients experienced significant gastrointestinal bleeding. Additional potentially fatal conditions included myocarditis, unpredictable rapid plasma leak, acute severe hepatitis, severe septic shock, cerebral hemorrhage, diarrhea, and decompensated dengue shock brought on by a third-space fluid leak. In addition to patient-specific proper fluid management, other empirical treatment approaches, such as blood transfusions, were employed. Early identification of the key phase was aided by bedside ultrasound screening. In all six cases, the patients fully recovered.

Conclusion: Even now, treating dengue remains one of the world's most difficult infections. Given the extremely narrow treatment window, the aforementioned atypical presentations and consequences could be lethal if not identified early. These are not uncommon issues that go unreported and are frequently disregarded, so clinicians must be aware of them. To enhance medical research and improve care in rural areas, every patient's clinical management was documented for knowledge sharing.