Congenital Dengue Infection: A Stormy Course of Refractory Thrombocytopenia and Bleeding in a Neonate

Background: Little is known in literature about neonates born to mothers with dengue infection. Clinical Description: A term male neonate was delivered by cesarean section due to oligohydramnios and rapidly deteriorating condition of the mother due to severe dengue. The baby developed petechiae over the right upper thigh within one hour of life, along with bleeding per rectum. Management and Outcome: Investigations revealed thrombocytopenia and a positive dengue NS1 antigen. As bleeding manifestations increased, platelets and fresh frozen plasma were transfused repeatedly along with an increased rate of fluids. Dengue enzyme-linked immunosorbent assay immunoglobulin-M was reported positive on the fifth day. Due to refractory thrombocytopenia, bleeding and worsening general condition, the neonate was administered intravenous immunoglobulin and pulse methylprednisolone. After a further 7 days, clinical improvement was seen along with improvement in platelet counts. Conclusion: The case shows the clinical course of a neonate born to a mother with dengue infection just before delivery. Congenital dengue can be severe with refractory thrombocytopenia and bleeding manifestations and may need judicious use of fluids and customized treatments.