The Neurological and Hemorrhagic Faces of Dengue: A Case of Encephalitis with Upper GI Bleed

Dengue fever is a mosquito-borne viral infection caused by the dengue virus, belonging to the Flavivirus genus and primarily transmitted by Aedes mosquitoes. It is prevalent in tropical and sub-tropical regions, affecting millions of people globally each year. The World Health Organization (WHO) estimates that about 390 million dengue infections occur annually, with approximately 96 million manifesting clinically. The epidemiology of dengue is influenced by several factors, including climate change, urbanization, and globalization, which facilitate the spread of the vector and the virus. While the typical presentation of dengue includes high-grade fever, headache, myalgia, arthralgia, and rash, the disease can escalate to more severe forms, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). These severe forms can lead to life-threatening complications, necessitating prompt recognition and intervention. DHF is characterized by plasma leakage, thrombocytopenia, and hemorrhagic manifestations, which can culminate in significant morbidity and mortality. The pathophysiology underlying these severe manifestations is complex and involves the interplay of the virus, host immune response, and genetic predisposition. Additionally, neurological involvement, such as dengue encephalitis, and gastrointestinal (GI) complications, such as upper GI bleeding, are rare but increasingly recognized complications. This case report describes the clinical course of a young adult male who initially presented with typical dengue symptoms but developed severe complications during hospitalization. His clinical course included the development of dengue encephalitis and upper GI bleeding, both of which were primarily driven by plasma leakage and dengue hemorrhagic fever. Through this case, we aim to shed light on the atypical manifestations of dengue fever and the importance of early recognition and management of these complications.