We report a case of bilateral eyelid ecchymosis and subconjunctival haemorrhage, a rare presenting feature of dengue haemorrhagic fever. A 17-year-old boy presented to the emergency department with complaints of redness in both eyes and vomiting. He had bilateral eyelid ecchymosis with subconjunctival haemorrhage. Complete blood count revealed a significantly reduced platelet count of 11000/µL suggestive of dengue haemorrhagic fever (DHF). Ocular manifestations were followed by other systemic haemorrhagic manifestations of dengue later on which violates the usual sequence of events of dengue fever. Bilateral eyelid ecchymosis is a rare clinical manifestation and a rare presenting feature of dengue fever and one has to keep high index of suspicion for presence of dengue whenever a case of fever presents with lid ecchymosis/haemorrhage.

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<p class="abstract"><strong>Background:</strong> Chronic kidney disease is associated with a variety of cutaneous manifestations as a result of underlying etiology as well as the various treatment modalities.</p><p class="abstract"><strong>Methods:</strong> A hospital based cross sectional study was carried out for two year among 100 diagnosed cases of chronic kidney disease admitted in the Department of General Medicine, Regional Institute of Medical Sciences, Manipur, India having at least one mucocutaneous manifestation. Complete clinical and dermatogical evaluation and relevant investigations were done in all patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were 57% male and 43% female patients. The maximum number of study subjects belonged to the age range of 41 to 60 years. Diabetes mellitus was the commonest (39%) cause of chronic kidney disease in this study, followed by hypertension (32%), chronic interstitial nephritis and chronic glomerulonephritis (9%) each, other diseases (7%) and obstructive uropathy (4%). Sixty three percent of the patients were managed under conservative therapy and rest (37%) was on dialysis. Xerosis (72%) was the most common cutaneous manifestation followed by pallor (64%), pruritis (56%), hyperpigmentation (51%), yellowish hue (21%), dermatitis (10%) and others (24%). Infectious skin manifestations were present in 43% of study population, among which fungal, bacterial, viral disease constituted 19%, 17% and 7% respectively. Mucosal changes, hair changes and nail changes were reported in 77%, 68%, 119% cases respectively.</p><p class="abstract"><strong>Conclusions:</strong> Early recognition and management of the dermatological manifestations vastly reduce the morbidity and improve the quality of life in chronic kidney disease patients.</p>

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