Case Presentation: A 65-year-old male with hypertension, hyperlipidemia, type 2 diabetes, and hypothyroidism was admitted to the hospital with fevers and chills in the setting of leukopenia and thrombocytopenia. Symptoms began on his way home from India four days prior and progressed to a Tmax of 102F with chest congestion. His physician ordered labwork that showed a platelet count of 114 and leukocytes of 2.3, and he was instructed to go to the hospital. Workup in the emergency department included a negative chest x-ray, normal urinalysis, and negative malaria, COVID-19, and influenza studies. Labs revealed AST of 97, ALT of 71, ANC of 740, and platelets downtrending to 95. The following day, his platelets reached a nadir at 87. Dengue fever was the primary concern based on the workup, his presentation, and his travel history. He subsequently improved with supportive care, and no further interventions were required prior to release the next day. After discharge, Zika and chikungunya serologies returned negative, while dengue serology was confirmed with an IgG of 13 and IgM of 1.51.
Discussion: This case demonstrates the growing emergence of dengue in non-endemic regions and emphasizes the need for greater awareness among healthcare professionals. As of November 2024, 7,587 dengue cases were reported in the United States (US) by the CDC, and hospitalization was confirmed for 45% of them. This is up from 2,540 in 2022 and more than double 3,352 in 2023. By August, the reported cases in India exceeded 32,000 compared to 18,000 reported during the same period in 2023, which raised the initial concern for this patient. Latin America has seen its worst dengue outbreak on record, with over 8.65 million cases in the first five months of 2024. According to the Pan American Health Organization, this is 238% higher than what was seen at the same time last year and 437% higher than the Latin American five-year average. Despite the WHO and CDC identifying dengue fever as the most common mosquito-borne disease worldwide, Dengvaxia, the only FDA-approved vaccine, will be discontinued in 2026. Although dengue is most often self-limiting, subclinical pancytopenia can progress to life-threatening dengue hemorrhagic fever, which develops in 1 in 20 patients. With the absence of chemoprophylaxis and an already increasing incidence, clinicians must be able to recognize dengue and its complications early to avoid excessive and extensive hospitalizations.
Conclusions: This patient benefited from early recognition of dengue based on history and presentation, allowing for optimal use of hospital resources. Given the potential development of life-threatening complications, having inpatient monitoring until confirming clinical and laboratory stability avoided a prolonged hospital course. Confirmation testing was able to be followed up as an outpatient. The US healthcare system needs to remain vigilant and educated regarding tropical diseases that are becoming more prevalent, specifically dengue, which is increasing at a dramatic rate. Identifying these cases early and anticipating who would benefit from inpatient versus outpatient observation would help keep hospitals from being overwhelmed as the incidence of previously uncommon diseases like dengue rises. Additionally, adopting practices from other countries that may already be facing these challenges might help mitigate the impact of the disease on healthcare systems in the US and improve outcomes overall.