Dengue

dok_zlo — 06.10.2023

A 23-year-old woman presented to the emergency department with a 1-day history of an itchy rash. Five days before presentation, fevers, chills, myalgias, nausea, anorexia, and a retro-orbital headache had developed. The symptoms lasted 4 days and had abated before presentation. Vital signs were normal. A physical examination was notable for a nonblanching, maculopapular, erythematous rash surrounding scattered patches of unaffected skin on the arms (Panel A), legs, and trunk (Panel B). The palms and soles were spared. There was no bruising or petechiae. A complete blood count showed leukopenia with lymphopenia; the platelet count was normal. Results of a rapid test for the dengue nonstructural protein 1 and serologic testing for dengue IgM were positive. A diagnosis of dengue was made. Dengue infection is classified into three phases: febrile, critical, and convalescent. In the convalescent phase of infection, a confluent, erythematous rash with small areas of unaffected skin that look like “islands in a sea of red” — as seen in this patient — may be present. The patient was reassured that her condition would continue to improve. Three days later, her rash had completely resolved. Erika P. Ong, M.D. Frances V. Ho, B.S. University of the Philippines College of Medicine, Manila, Philippines October 5, 2023 N Engl J Med 2023; 389:e28 DOI: 10.1056/NEJMicm2305074

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