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Case Reports
. 2021 Jan-Mar;11(1):39-42.
doi: 10.4103/IJCIIS.IJCIIS_109_19. Epub 2021 Mar 27.

Expanded dengue syndrome with small-medium-vessel vasculitis: A case report

Augustine Jose  1 , Minakshi Dhar  1 , Prasan Kumar Panda  1 , Sanjeev Kishore  2
Affiliations
Case Reports

Expanded dengue syndrome with small-medium-vessel vasculitis: A case report

Augustine Jose et al. Int J Crit Illn Inj Sci. 2021 Jan-Mar.

Abstract

Expanded dengue syndrome (EDS) is a well-described entity in the literature (after 2009), with various new atypical presentations being identified each year. We report a case of 38-year-old man who presented to the emergency department with high-grade, intermittent fever for 7 days along with myalgia and headache. He had multiple painless palpable purpura over both lower limbs and breathlessness from the 4th day of fever. On admission, purpura progressed in the severity and dry impending gangrene of the toes of both feet developed. Blood cultures turned out to be sterile, and other infectious markers (malaria, scrub typhus, and chikungunya) were negative except for dengue serology (enzyme-linked immunosorbent assay-immunoglobulin M [ELISA-IgM]). Skin biopsy confirmed to be cutaneous small-vessel vasculitis. The respiratory distress was due to myocarditis (supported by raised NT-pro-BNP levels) and pulmonary edema. He also had possibly hemolytic anemia due to microangiopathy. Although there are many EDS cases of dengue myocarditis reported till date, dengue resulting in widespread endothelial activation and extensive vasculitis (small vessel due to purpura and medium vessel due to gangrene) is a rare phenomenon.

Keywords: Gangrene; leukocytoclastic vasculitis; myocarditis; severe dengue.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Patient monographs. (a and b) Painful palpable purpura in both lower limbs during initial days of dengue illness. (c) Healing stage of impending gangrene after dengue recovery, (d) Chest X-ray posteroanterior-view with increasing perihilar vascular congestion due to left ventricular failure after dengue myocarditis
Figure 2
Figure 2
Skin biopsy photomicrographs. Low-power photomicrograph of skin biopsy (H and E, ×4) (a). Superficial dermis showing focal perivascular inflammatory cell infiltrates with nuclear fragmentation (H and E × 20) (b), suggestive of leukocytoclastic or cutaneous small-vessel vasculitis, focused in the high-power micrograph and inset
See this image and copyright information in PMC

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