Case report
Dengue Fever Complicated by Intracerebral Haemorrhage, Acute Respiratory Failure and Nosocomial Pneumonia: A Case Report
OD15-OD18
Correspondence
Dr. Ronak Shah,
104, Nakshtra Enclave Apartment, Behind Bright School, Near Amit Complex, VIP Road, Karelibaugh, Vadodara-390018, Gujarat, India.
E-mail: drronakshah88@gmail.com
Dengue fever is a mosquito-borne viral illness caused by the dengue virus. Majority of cases have self-limiting course, rarely severe dengue causes fatal neurological complications like encephalitis and haemorrhage. This is case report of a 38-year-old male who presented with three days of high-grade fever, one day of altered sensorium, headache, and generalised weakness. Serological testing confirmed dengue IgM positivity. The clinical course was complicated by a rapid decline in Glasgow Coma Scale (GCS) from 15 to 11, necessitating endotracheal intubation on day two in the setting of blood-stained pulmonary secretions. High-resolution Computed Tomography (CT) of the thorax suggested consolidation with pulmonary oedema. CT of the brain revealed a 3.9×3.8×3.5 cm Intracerebral Parenchymal Haemorrhage (IPH) with surrounding oedema causing significant mass effect. Laboratory parameters documented severe thrombocytopaenia (nadir 0.6 lac/cumm), coagulopathy, hepatocellular injury with peak SGOT/SGPT of 227/276 IU/L, and elevated C-reactive protein at 85.6 mg/L. Endotracheal aspirate cultures grew extensively drug-resistant Acinetobacter baumannii on day five, requiring escalation of antimicrobial therapy to meropenem and polymyxin. Supportive management included platelet and Fresh Frozen Plasma (FFP) transfusion. The patient was successfully extubated on day nine and discharged home on day twelve. Notably, the simultaneous occurrence of dengue-associated Intracerebral Haemorrhage (ICH), acute hypoxaemic respiratory failure, and Multi-Drug Resistant (MDR) nosocomial pneumonia in a young immunocompetent adult represents a triad that is rarely documented in the published literature. Early recognition of neurological deterioration, timely neuroimaging, aggressive blood product support, and targeted antimicrobial therapy with conservative management of ICH remains critical determinants of a favourable outcome.