The Neurological and Hemorrhagic Faces of Dengue: A Case of Encephalitis with Upper GI Bleed

Waqar Hafeez; Muhammad Abdullah Ashraf; Fatima Asif; Hafiz Muhammad Arbaz; Muhammad Umar; Muhammad Hassaan

doi:doi:10.11648/j.ajim.20241206.14

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The Neurological and Hemorrhagic Faces of Dengue: A Case of Encephalitis with Upper GI Bleed

Waqar Hafeez^*

, Muhammad Abdullah Ashraf

, Fatima Asif

, Hafiz Muhammad Arbaz

, Muhammad Umar

, Muhammad Hassaan

Published in American Journal of Internal Medicine (Volume 12, Issue 6)

Received: 30 November 2024 Accepted: 11 December 2024 Published: 27 December 2024

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Abstract

Dengue fever is a mosquito-borne viral infection caused by the dengue virus, belonging to the Flavivirus genus and primarily transmitted by Aedes mosquitoes. It is prevalent in tropical and sub-tropical regions, affecting millions of people globally each year. The World Health Organization (WHO) estimates that about 390 million dengue infections occur annually, with approximately 96 million manifesting clinically. The epidemiology of dengue is influenced by several factors, including climate change, urbanization, and globalization, which facilitate the spread of the vector and the virus. While the typical presentation of dengue includes high-grade fever, headache, myalgia, arthralgia, and rash, the disease can escalate to more severe forms, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). These severe forms can lead to life-threatening complications, necessitating prompt recognition and intervention. DHF is characterized by plasma leakage, thrombocytopenia, and hemorrhagic manifestations, which can culminate in significant morbidity and mortality. The pathophysiology underlying these severe manifestations is complex and involves the interplay of the virus, host immune response, and genetic predisposition. Additionally, neurological involvement, such as dengue encephalitis, and gastrointestinal (GI) complications, such as upper GI bleeding, are rare but increasingly recognized complications. This case report describes the clinical course of a young adult male who initially presented with typical dengue symptoms but developed severe complications during hospitalization. His clinical course included the development of dengue encephalitis and upper GI bleeding, both of which were primarily driven by plasma leakage and dengue hemorrhagic fever. Through this case, we aim to shed light on the atypical manifestations of dengue fever and the importance of early recognition and management of these complications.

Published in	American Journal of Internal Medicine (Volume 12, Issue 6)
DOI	10.11648/j.ajim.20241206.14
Page(s)	125-130
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Dengue, Flavivirus, Aedes, Rash, Plasma Leakage, Dengue Encephalitis, Upper GI Bleeding, Myalgia, Fever, Hem-concentration, Thrombocytopenia

References

[1]	Baheti, G., Mehta, V., Ramchandani, M., & Ghosh, G. C. Dengue fever with encephalitis: a rare phenomenon. BMJ Case Reports. 2018. https://doi.org/10.1136/bcr-2018-225463
[2]	Rao, S., Kumar, M., Ghosh, S., & Gadpayle, A. K. A rare case of dengue encephalitis. BMJ Case Reports. 2013. https://doi.org/10.1136/bcr-2012-008229
[3]	Baldaçara, L., et al. Neuroimaging of dengue encephalitis: MRI findings in a case report. Frontiers in Neurology. 2013. https://doi.org/10.3389/fneur.2013.00090
[4]	Madi, D., & Acharya, V. Atypical manifestations of dengue fever. Journal of Clinical and Diagnostic Research. 2015 Jun; 9(6): OD09–OD10. https://doi.org/10.7860/JCDR/2015/13688.6092
[5]	Misra, U. K., & Kalita, J. Dengue fever and encephalopathy. Journal of Neurology, Neurosurgery & Psychiatry. 2006 Aug; 77(8): 970–973. https://doi.org/10.1136/jnnp.2005.078212
[6]	Garg, R. K., Malhotra, H. S., & Kumar, N. Encephalopathy in dengue fever: Clinical and neuroimaging manifestations. Journal of Neurological Sciences. 2017 Jan; 373: 1–8. https://doi.org/10.1016/j.jns.2017.01.043
[7]	Liou, L. M., et al. Acute encephalopathy in patients with dengue fever. Journal of the Neurological Sciences. 2008 Aug; 272(1-2): 103–105. https://doi.org/10.1016/j.jns.2008.05.016
[8]	Thisyakorn, U., & Thisyakorn, C. Neurological manifestations in dengue patients. Pediatric Infectious Disease Journal. 2001 May; 20(5): 458–459. https://doi.org/10.1097/00006454-200105000-00019
[9]	Sumarmo, S., et al. Encephalopathy associated with dengue haemorrhagic fever. Journal of Neurology, Neurosurgery, and Psychiatry. 1983 Aug; 46(8): 779–785. https://doi.org/10.1136/jnnp.46.8.779
[10]	Yung, C. F., et al. Dengue serotype-specific differences in clinical manifestations, laboratory findings, and outcomes. PLoS ONE. 2015 Dec; 10(12): e0123822. https://doi.org/10.1371/journal.pone.0123822
[11]	Hendarto, S. K., & Hadinegoro, S. Dengue encephalopathy in children. Journal of Pediatric Infectious Diseases. 1992 Jun; 11(6): 1121–1123.
[12]	Gupta, N., Srivastava, S., Jain, A., & Chaturvedi, U. C. Dengue in India. Indian Journal of Medical Research. 2012 Mar; 136(3): 373–390. https://doi.org/10.4103/ijmr.IJMR_364_12
[13]	Guzman, M. G., & Harris, E. Dengue. The Lancet. 2015 Feb 7; 385(9966): 453–465. https://doi.org/10.1016/S0140-6736(14)60572-9
[14]	Sahu, R., et al. Neurological complications in dengue infection: A study of hospital-based patients. Asian Pacific Journal of Tropical Medicine. 2014 Mar; 7(3): 253–256.

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APA Style

Hafeez, W., Ashraf, M. A., Asif, F., Arbaz, H. M., Umar, M., et al. (2024). The Neurological and Hemorrhagic Faces of Dengue: A Case of Encephalitis with Upper GI Bleed. American Journal of Internal Medicine, 12(6), 125-130. https://doi.org/10.11648/j.ajim.20241206.14

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ACS Style

Hafeez, W.; Ashraf, M. A.; Asif, F.; Arbaz, H. M.; Umar, M., et al. The Neurological and Hemorrhagic Faces of Dengue: A Case of Encephalitis with Upper GI Bleed. Am. J. Intern. Med. 2024, 12(6), 125-130. doi: 10.11648/j.ajim.20241206.14

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AMA Style

Hafeez W, Ashraf MA, Asif F, Arbaz HM, Umar M, et al. The Neurological and Hemorrhagic Faces of Dengue: A Case of Encephalitis with Upper GI Bleed. Am J Intern Med. 2024;12(6):125-130. doi: 10.11648/j.ajim.20241206.14

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@article{10.11648/j.ajim.20241206.14,
  author = {Waqar Hafeez and Muhammad Abdullah Ashraf and Fatima Asif and Hafiz Muhammad Arbaz and Muhammad Umar and Muhammad Hassaan},
  title = {The Neurological and Hemorrhagic Faces of Dengue: A Case of Encephalitis with Upper GI Bleed
},
  journal = {American Journal of Internal Medicine},
  volume = {12},
  number = {6},
  pages = {125-130},
  doi = {10.11648/j.ajim.20241206.14},
  url = {https://doi.org/10.11648/j.ajim.20241206.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20241206.14},
  abstract = {Dengue fever is a mosquito-borne viral infection caused by the dengue virus, belonging to the Flavivirus genus and primarily transmitted by Aedes mosquitoes. It is prevalent in tropical and sub-tropical regions, affecting millions of people globally each year. The World Health Organization (WHO) estimates that about 390 million dengue infections occur annually, with approximately 96 million manifesting clinically. The epidemiology of dengue is influenced by several factors, including climate change, urbanization, and globalization, which facilitate the spread of the vector and the virus. While the typical presentation of dengue includes high-grade fever, headache, myalgia, arthralgia, and rash, the disease can escalate to more severe forms, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). These severe forms can lead to life-threatening complications, necessitating prompt recognition and intervention. DHF is characterized by plasma leakage, thrombocytopenia, and hemorrhagic manifestations, which can culminate in significant morbidity and mortality. The pathophysiology underlying these severe manifestations is complex and involves the interplay of the virus, host immune response, and genetic predisposition. Additionally, neurological involvement, such as dengue encephalitis, and gastrointestinal (GI) complications, such as upper GI bleeding, are rare but increasingly recognized complications. This case report describes the clinical course of a young adult male who initially presented with typical dengue symptoms but developed severe complications during hospitalization. His clinical course included the development of dengue encephalitis and upper GI bleeding, both of which were primarily driven by plasma leakage and dengue hemorrhagic fever. Through this case, we aim to shed light on the atypical manifestations of dengue fever and the importance of early recognition and management of these complications.
},
 year = {2024}
}

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TY  - JOUR
T1  - The Neurological and Hemorrhagic Faces of Dengue: A Case of Encephalitis with Upper GI Bleed

AU  - Waqar Hafeez
AU  - Muhammad Abdullah Ashraf
AU  - Fatima Asif
AU  - Hafiz Muhammad Arbaz
AU  - Muhammad Umar
AU  - Muhammad Hassaan
Y1  - 2024/12/27
PY  - 2024
N1  - https://doi.org/10.11648/j.ajim.20241206.14
DO  - 10.11648/j.ajim.20241206.14
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
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EP  - 130
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20241206.14
AB  - Dengue fever is a mosquito-borne viral infection caused by the dengue virus, belonging to the Flavivirus genus and primarily transmitted by Aedes mosquitoes. It is prevalent in tropical and sub-tropical regions, affecting millions of people globally each year. The World Health Organization (WHO) estimates that about 390 million dengue infections occur annually, with approximately 96 million manifesting clinically. The epidemiology of dengue is influenced by several factors, including climate change, urbanization, and globalization, which facilitate the spread of the vector and the virus. While the typical presentation of dengue includes high-grade fever, headache, myalgia, arthralgia, and rash, the disease can escalate to more severe forms, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). These severe forms can lead to life-threatening complications, necessitating prompt recognition and intervention. DHF is characterized by plasma leakage, thrombocytopenia, and hemorrhagic manifestations, which can culminate in significant morbidity and mortality. The pathophysiology underlying these severe manifestations is complex and involves the interplay of the virus, host immune response, and genetic predisposition. Additionally, neurological involvement, such as dengue encephalitis, and gastrointestinal (GI) complications, such as upper GI bleeding, are rare but increasingly recognized complications. This case report describes the clinical course of a young adult male who initially presented with typical dengue symptoms but developed severe complications during hospitalization. His clinical course included the development of dengue encephalitis and upper GI bleeding, both of which were primarily driven by plasma leakage and dengue hemorrhagic fever. Through this case, we aim to shed light on the atypical manifestations of dengue fever and the importance of early recognition and management of these complications.

VL  - 12
IS  - 6
ER  -

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Author Information

Waqar Hafeez

Shalamar Hospital, Shalamar Institute of Health Sciences, Lahore, Pakistan

Contact Email

http://orcid.org/0009-0003-9442-9130
Muhammad Abdullah Ashraf

Shalamar Hospital, Shalamar Institute of Health Sciences, Lahore, Pakistan

Contact Email

http://orcid.org/0009-0007-8905-7941
Fatima Asif

Shalamar Hospital, Shalamar Institute of Health Sciences, Lahore, Pakistan

Contact Email

http://orcid.org/0009-0005-3582-8144
Hafiz Muhammad Arbaz

Shalamar Hospital, Shalamar Institute of Health Sciences, Lahore, Pakistan

Contact Email

http://orcid.org/0009-0005-3995-2978
Muhammad Umar

Shalamar Hospital, Shalamar Institute of Health Sciences, Lahore, Pakistan

Contact Email

http://orcid.org/0009-0001-1068-5416
Muhammad Hassaan

Shalamar Hospital, Shalamar Institute of Health Sciences, Lahore, Pakistan

Contact Email

http://orcid.org/0009-0009-7956-9083

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Plain Text BibTeX RIS

APA Style

Hafeez, W., Ashraf, M. A., Asif, F., Arbaz, H. M., Umar, M., et al. (2024). The Neurological and Hemorrhagic Faces of Dengue: A Case of Encephalitis with Upper GI Bleed. American Journal of Internal Medicine, 12(6), 125-130. https://doi.org/10.11648/j.ajim.20241206.14

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ACS Style

Hafeez, W.; Ashraf, M. A.; Asif, F.; Arbaz, H. M.; Umar, M., et al. The Neurological and Hemorrhagic Faces of Dengue: A Case of Encephalitis with Upper GI Bleed. Am. J. Intern. Med. 2024, 12(6), 125-130. doi: 10.11648/j.ajim.20241206.14

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AMA Style

Hafeez W, Ashraf MA, Asif F, Arbaz HM, Umar M, et al. The Neurological and Hemorrhagic Faces of Dengue: A Case of Encephalitis with Upper GI Bleed. Am J Intern Med. 2024;12(6):125-130. doi: 10.11648/j.ajim.20241206.14

Copy | Download

@article{10.11648/j.ajim.20241206.14,
  author = {Waqar Hafeez and Muhammad Abdullah Ashraf and Fatima Asif and Hafiz Muhammad Arbaz and Muhammad Umar and Muhammad Hassaan},
  title = {The Neurological and Hemorrhagic Faces of Dengue: A Case of Encephalitis with Upper GI Bleed
},
  journal = {American Journal of Internal Medicine},
  volume = {12},
  number = {6},
  pages = {125-130},
  doi = {10.11648/j.ajim.20241206.14},
  url = {https://doi.org/10.11648/j.ajim.20241206.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20241206.14},
  abstract = {Dengue fever is a mosquito-borne viral infection caused by the dengue virus, belonging to the Flavivirus genus and primarily transmitted by Aedes mosquitoes. It is prevalent in tropical and sub-tropical regions, affecting millions of people globally each year. The World Health Organization (WHO) estimates that about 390 million dengue infections occur annually, with approximately 96 million manifesting clinically. The epidemiology of dengue is influenced by several factors, including climate change, urbanization, and globalization, which facilitate the spread of the vector and the virus. While the typical presentation of dengue includes high-grade fever, headache, myalgia, arthralgia, and rash, the disease can escalate to more severe forms, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). These severe forms can lead to life-threatening complications, necessitating prompt recognition and intervention. DHF is characterized by plasma leakage, thrombocytopenia, and hemorrhagic manifestations, which can culminate in significant morbidity and mortality. The pathophysiology underlying these severe manifestations is complex and involves the interplay of the virus, host immune response, and genetic predisposition. Additionally, neurological involvement, such as dengue encephalitis, and gastrointestinal (GI) complications, such as upper GI bleeding, are rare but increasingly recognized complications. This case report describes the clinical course of a young adult male who initially presented with typical dengue symptoms but developed severe complications during hospitalization. His clinical course included the development of dengue encephalitis and upper GI bleeding, both of which were primarily driven by plasma leakage and dengue hemorrhagic fever. Through this case, we aim to shed light on the atypical manifestations of dengue fever and the importance of early recognition and management of these complications.
},
 year = {2024}
}

Copy | Download

TY  - JOUR
T1  - The Neurological and Hemorrhagic Faces of Dengue: A Case of Encephalitis with Upper GI Bleed

AU  - Waqar Hafeez
AU  - Muhammad Abdullah Ashraf
AU  - Fatima Asif
AU  - Hafiz Muhammad Arbaz
AU  - Muhammad Umar
AU  - Muhammad Hassaan
Y1  - 2024/12/27
PY  - 2024
N1  - https://doi.org/10.11648/j.ajim.20241206.14
DO  - 10.11648/j.ajim.20241206.14
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 125
EP  - 130
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20241206.14
AB  - Dengue fever is a mosquito-borne viral infection caused by the dengue virus, belonging to the Flavivirus genus and primarily transmitted by Aedes mosquitoes. It is prevalent in tropical and sub-tropical regions, affecting millions of people globally each year. The World Health Organization (WHO) estimates that about 390 million dengue infections occur annually, with approximately 96 million manifesting clinically. The epidemiology of dengue is influenced by several factors, including climate change, urbanization, and globalization, which facilitate the spread of the vector and the virus. While the typical presentation of dengue includes high-grade fever, headache, myalgia, arthralgia, and rash, the disease can escalate to more severe forms, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). These severe forms can lead to life-threatening complications, necessitating prompt recognition and intervention. DHF is characterized by plasma leakage, thrombocytopenia, and hemorrhagic manifestations, which can culminate in significant morbidity and mortality. The pathophysiology underlying these severe manifestations is complex and involves the interplay of the virus, host immune response, and genetic predisposition. Additionally, neurological involvement, such as dengue encephalitis, and gastrointestinal (GI) complications, such as upper GI bleeding, are rare but increasingly recognized complications. This case report describes the clinical course of a young adult male who initially presented with typical dengue symptoms but developed severe complications during hospitalization. His clinical course included the development of dengue encephalitis and upper GI bleeding, both of which were primarily driven by plasma leakage and dengue hemorrhagic fever. Through this case, we aim to shed light on the atypical manifestations of dengue fever and the importance of early recognition and management of these complications.

VL  - 12
IS  - 6
ER  -

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