Fatal subarachnoidal haemorrhage in a Norwegian traveller with dengue virus infection

Abstract

We present a Norwegian female in her thirties who acquired dengue fever caused by dengue virus serotype 2 while travelling to Mexico. When hospitalised 3 days after symptom onset, the patient had severe headache, fever, rash and a positive tourniquet test, but did not fulfil the criteria of dengue haemorrhagic fever (DHF). Five days later she developed a fatal subarachnoidal haemorrhage. A post-mortem examination failed to reveal any intracranial arterial aneurysm. Our case was consistent with so called 'dengue fever with haemorrhages', a recently described entity that mainly affects adults and may cause severe bleedings also in the absence of DHF.

Severe Dengue Virus Infection in Travelers: Risk Factors and Laboratory Indicators

“…This temporary cross-immunity might explain to some extent why DHF is rarely seen in travelers. Nonetheless, fatal dengue associated with fulminant hepatic failure [14] or subarachnoidal hemorrhage [15] have recently been reported in travelers. Severe manifestations of dengue virus infection, such as encephalitis [16] or visual loss [17], have also been reported in returning travelers in recent years.…”

Febrile illness in a returned traveller from Thailand

“…Only two published case reports with a fatal outcome from a primary infection were found in the European literature, both with intracerebral haemorrhage, 17,18 The American MMWR Surveillance Summaries Report identified only one fatal dengue case among 157 diagnosed during 1986-1992, 19 whereas two deaths are reported among more than 200 diagnosed between 1993 and 2000. 8 The dengue virus antibody dependent enhancement theory advocates severe outcome of a subsequent, secondary dengue viral infection.…”

Dengue Hemorrhagic Fever: A Rare Presentation as Atypical Acute Subdural Hematoma

“…Various forms of intracranial hemorrhages in dengue have been reported but mostly they are of the parenchymal type. Pure subdural hematoma has not been reported in dengue so far [2, 5]. …”

“…Intracranial hemorrhages are uncommon as compared to common hemorrhagic manifestations of dengue fever like hematemesis, melena or epistaxis. They may be higher in incidence, but because of the fatal nature most cases might not be diagnosed till death [4,5,6]. …”