Spontaneous Tumor Bleed with Subarachnoid Hemorrhage in Conus Ependymoma with COVID-19 and Dengue Co-Infection—A Case Report

Abstract Spinal subarachnoid hemorrhage (SAH) is a rare complication of dengue-associated thrombocytopenia. Hemorrhagic manifestations have also been infrequently reported with coronavirus disease 2019 (COVID-19) infections. However, the clinical implications of COVID-19 and dengue coinfections remain poorly understood and may be severe. We report the case of a 32-year-old man with COVID 19 and dengue coinfection complicated by severe thrombocytopenia, who subsequently developed an acute-onset neurological deficit below the L1 level. Magnetic resonance imaging demonstrated spontaneous spinal SAH, and the patient underwent decompressive surgery with simultaneous platelet transfusion support. Histopathological examination of the clot tissue unexpectedly revealed an underlying ependymoma. Following decompression, platelet correction, and structured rehabilitation, the patient showed gradual neurological recovery and regained the ability to walk. This case highlights that thrombocytopenia-related intraspinal hemorrhage should be considered a rare but important cause of acute neurological deficit in patient with COVID-19 and dengue coinfection. It also emphasizes the importance of maintaining a high index of suspicion for underlying intraspinal pathology and obtaining tissue diagnosis when feasible.