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Abstract
Background: Dengue fever, a mosquito-borne viral illness, is endemic in tropical regions, including border regions like the Rio Grande Valley while often self-limited, severe presentations such as dengue hemorrhagic fever and dengue shock syndrome highlight its challenges and complexities. This report describes an atypical dengue case with severe hematological manifestations, underscoring the diagnostic challenges and the importance of early recognition, multidisciplinary evaluation, and evidence-based management.
Case Presentation: A 22-year-old Hispanic female with no significant past medical history presented to the ED with hematemesis and fever following her travel to Monterrey, Mexico. Initial symptoms included high fever (107.6°F), chills, diarrhea, vomiting, severe headaches, light sensitivity, and hematuria. She tested positive for dengue at a private clinic in Matamoros, Mexico, and was treated symptomatically before presenting to the U.S. hospital. Laboratory findings revealed severe leukopenia, neutropenia, mild thrombocytopenia, and transaminitis without clinical evidence of plasma leakage. Her physical exam was notable for petechial rash and ecchymosis over the extensor surfaces of the upper extremities. Despite mild thrombocytopenia, she experienced hematuria and hematemesis, prompting evaluation for bleeding risks. Bone marrow biopsy findings included erythroid hypoplasia, megakaryocytic hyperplasia, and a reactive myeloid maturation pattern, ruling out primary hematologic disorders. Cytogenetic studies identified a Robertsonian translocation, deemed a constitutional abnormality unrelated to her presentation. The patient was managed with hydration, antipyretics, antiemetics, and supportive care. Her symptoms and laboratory abnormalities improved by day five, and she was discharged in stable condition with outpatient follow-up.
Conclusion: This case highlights the importance of recognizing atypical dengue presentations, especially in endemic-bordering regions like the Rio Grande Valley, TX. Severe hematological abnormalities, such as leukopenia and neutropenia, may mimic other systemic or hematologic conditions, necessitating a thorough diagnostic workup. Multidisciplinary evaluation, including bone marrow biopsy and cytogenetic studies, plays a vital role in ruling out alternative etiologies. Evidence-based supportive care, including hydration and close monitoring, remains the cornerstone of treatment. This report underscores the importance of early diagnosis and supportive care for optimal outcomes and contributes to understanding dengue’s variable clinical presentations.
Recommended Citation
Arellano Villanueva, Elias; Asaad, Alhasan; and Campo Maldonado, Jose, "Atypical Dengue Fever with Severe Hematological Manifestations: A Case from the Rio Grande Valley" (2025). Research Symposium. 58.
https://scholarworks.utrgv.edu/somrs/2025/posters/58
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Diagnosis Commons, Hematology Commons, Hemic and Lymphatic Diseases Commons, Infectious Disease Commons, Internal Medicine Commons, Interprofessional Education Commons, Virus Diseases Commons
Atypical Dengue Fever with Severe Hematological Manifestations: A Case from the Rio Grande Valley
Background: Dengue fever, a mosquito-borne viral illness, is endemic in tropical regions, including border regions like the Rio Grande Valley while often self-limited, severe presentations such as dengue hemorrhagic fever and dengue shock syndrome highlight its challenges and complexities. This report describes an atypical dengue case with severe hematological manifestations, underscoring the diagnostic challenges and the importance of early recognition, multidisciplinary evaluation, and evidence-based management.
Case Presentation: A 22-year-old Hispanic female with no significant past medical history presented to the ED with hematemesis and fever following her travel to Monterrey, Mexico. Initial symptoms included high fever (107.6°F), chills, diarrhea, vomiting, severe headaches, light sensitivity, and hematuria. She tested positive for dengue at a private clinic in Matamoros, Mexico, and was treated symptomatically before presenting to the U.S. hospital. Laboratory findings revealed severe leukopenia, neutropenia, mild thrombocytopenia, and transaminitis without clinical evidence of plasma leakage. Her physical exam was notable for petechial rash and ecchymosis over the extensor surfaces of the upper extremities. Despite mild thrombocytopenia, she experienced hematuria and hematemesis, prompting evaluation for bleeding risks. Bone marrow biopsy findings included erythroid hypoplasia, megakaryocytic hyperplasia, and a reactive myeloid maturation pattern, ruling out primary hematologic disorders. Cytogenetic studies identified a Robertsonian translocation, deemed a constitutional abnormality unrelated to her presentation. The patient was managed with hydration, antipyretics, antiemetics, and supportive care. Her symptoms and laboratory abnormalities improved by day five, and she was discharged in stable condition with outpatient follow-up.
Conclusion: This case highlights the importance of recognizing atypical dengue presentations, especially in endemic-bordering regions like the Rio Grande Valley, TX. Severe hematological abnormalities, such as leukopenia and neutropenia, may mimic other systemic or hematologic conditions, necessitating a thorough diagnostic workup. Multidisciplinary evaluation, including bone marrow biopsy and cytogenetic studies, plays a vital role in ruling out alternative etiologies. Evidence-based supportive care, including hydration and close monitoring, remains the cornerstone of treatment. This report underscores the importance of early diagnosis and supportive care for optimal outcomes and contributes to understanding dengue’s variable clinical presentations.
