Extensive intraventricular hemorrhage, complicated by dengue-induced coagulopathy, initially misdiagnosed as gastroenteritis in a toddler: A case report

Incomplete physical examinations especially omissions of Central nervous system (CNS) assessments remain a major cause of missed or delayed diagnoses of serious neurological conditions in febrile children with nonspecific symptoms. I report the case of a 22-month-old male initially presenting with prolonged fever, coffee-ground vomiting, nonbloody diarrhea, and recurrent convulsions, leading to a presumptive diagnosis of gastroenteritis with sepsis at Mwananyamala regional referral hospital. Despite initial management, his condition deteriorated. Subsequent evaluation at Muhimbili National Hospital revealed focal neurological deficits, hepatomegaly with jaundice, and severe coagulopathy. Brain magnetic resonance imaging (MRI) demonstrated extensive intraventricular hemorrhage with obstructive hydrocephalus and multifocal acute cerebral infarcts in the setting of severe dengue-associated coagulopathy. Although an underlying vascular malformation was considered, vascular imaging was not performed and this remained unconfirmed. This case highlights the critical diagnostic challenge in pediatric care where common gastrointestinal symptoms can mask severe systemic and neurological conditions, particularly in dengue-endemic areas. It highlights the urgent need for high suspicion of central nervous system pathology, comprehensive neurological examinations, and early neuroimaging in children presenting with persistent nonspecific symptoms and new-onset seizures, crucial for timely diagnosis and management.