Severe Hepatic Injury Due to Dengue Fever Without Warning Signs in a Patient With Intellectual Disability: A Case Report

Dengue fever is a mosquito-borne arboviral disease prevalent in tropical countries that presents as a spectrum of symptoms ranging from mild fever to severe life-threatening illness with multi-organ dysfunction. Hepatic involvement is common in dengue fever, but it is usually mild and self-limiting. However, in some cases, it can present with acute liver failure, leading to a diagnostic dilemma. We present the case of a young man with developmental delay and a history of mosquito bites, who presented with dengue fever and severe viral hepatitis. A 20-year-old Saudi man presented to the emergency department with elevated liver enzyme levels, fever, decreased oral intake, nausea, abdominal pain, dysuria, dizziness, and confusion. He had been bitten by a mosquito 10 days before symptom onset. The patient was initially treated conservatively with paracetamol and hydration, but he developed progressive liver dysfunction. Laboratory evaluation revealed elevated liver enzyme levels, thrombocytopenia, and hyperferritinemia, with positive NS1 suggestive of acute liver injury. However, the viral hepatitis panel and infection workup gave negative results, and abdominal ultrasonography showed no evidence of biliary obstruction or structural liver disease. In conclusion, dengue fever is a prevalent tropical disease that can cause severe hepatic injury and acute liver failure. Clinicians should be aware of the possibility of severe liver injury in patients with dengue fever, particularly in those with risk factors for severe disease. Prompt recognition and appropriate management of these conditions are essential for preventing fatal outcomes.