Expanded dengue syndrome in diabetic patient with history of COVID-19 infection: a case report

Abstract

Introduction: Overlapping symptoms between dengue and COVID-19 may become diagnostic challenge; moreover, social stigma and fear of being diagnosed with COVID-19 may lead the patients to delayed medical visit. Delayed medical management of dengue may lead to expanded dengue syndrome and fatal outcome. Case Presentation: A 35-year-old female patient with uncontrolled diabetes mellitus and recent COVID-19 infection presented with continuous fever for four days. She delayed seeking medical advice due to traumatized being infected by COVID-19, self-isolation protocol, and COVID-19 protocol in every hospital for every febrile patient. She developed multi organ failure during hospitalization and was diagnosed with expanded dengue syndrome. Clinical Discussion: Diagnosing the etiology of acute febrile illness in the COVID-19 pandemic era is problematic. Most of healthcare facilities warranted COVID-19 evaluation in every acute febrile patient. This protocol may lead to potential delayed diagnosis and serve as a barrier to accessing healthcare facility. False perception, fear and anxiety of being isolated, discrimination in society, and others may lead to stigmatization of COVID-19 and affect the individual decision for COVID-19 testing and seeking medical advices. Our patient had a fatal outcome due to delayed detection and treatment of dengue hemorrhagic fever. Conclusion: Delayed management of expanded dengue syndrome leads to fatal outcome. Stigma may play role as the barrier for seeking medical advice. Having broad differential diagnosis in COVID-19 pandemic era is essential.