Concomitant acute pulmonary embolism in recent dengue virus infection in an endemic country: case series.

Background: There is a substantial gap in the understanding of dengue fever pathogenesis and pathophysiology concerning haemostatic equilibrium alteration. While haemorrhagic manifestation is common in dengue infection, the alteration towards venous thromboembolism (VTE) event is also known despite being infrequently reported. The VTE spectrum is composed of deep vein thrombosis (DVT) and pulmonary embolism (PE). Case summary: We reported six cases in similar presentation of acute shortness of breath in the recent phase of dengue virus infection. All patients had increased serum D-dimer level with clinical criteria of pulmonary thromboembolism. Four of six patients had pulmonary thrombosis confirmation from pulmonary angiography computed tomography imaging. The patients were diagnosed with acute pulmonary thrombosis in the setting of recent dengue infection. Parenteral and oral anticoagulants were administered in all patients with favourable outcome in five patients but one patient died during admission. Discussion: Haemorrhagic manifestation concern made the PE complication in dengue infection patients often overlooked. Significant clinical challenges arise upon the decision to treat PE pharmacologically in the clinical setting of haemorrhagic diathesis; anticoagulants in dengue are somewhat questionable and meet clinical dilemmas. Although PE is uncommonly described as a dengue complication, this may be an underlying mechanism in which well-known complication in dengue commonly described such as circulatory collapse. This has become a challenge for clinicians to broaden the differential diagnosis to include PE in the setting of complicated dengue infection. Clinician vigilance to increase awareness of thrombotic complication in dengue is of utmost importance especially in the endemic area hospital settings.