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Case 151


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In the month of March, a 28-year-old female patient attends to the emergency room with nausea and intense vomiting, myalgia and pruriginous skin rash in the past 3 days, as shown in the pictures. Denies fever or bleeding. Laboratory tests: hemoglobin: 11,8g/dl; hematocrit: 31,2%; leucocytes: 11.000/mm3; platelets: 43.000/mm3; VDRL: negative; rapid test for viral antigens/NS1 for dengue fever: positive.

Based on the clinical picture and the laboratory tests depicted, what is the severity classification of this patient?

a) Group A


b) Group B


c) Group C


d) Group D


Image analysis

The dengue fever skin rash is highly variable, generally compressible with taints and papules. In this case, there are predominant petechiae in hand and forearms and, in the palms, an intensive and scaly erythema is seen.

Relevant aspects

- The dengue fever is caused by one of the most important arboviruses in the world, being endemic in Americas, Asia, Africa and Australia. The estimated incidence is around 50 to 100 millions cases per year.

- It can either manifest in a benign way, such as in the classical dengue fever, or severe, in the hemorrhagic fever or in the dengue shock syndrome.

- The infection by one of the 4 serotypes does not confer crossed immunity, in a way that the same person may have up to 4 infections in a lifetime.

- The clinical picture includes fever, myalgia, arthralgia, headache, retro-orbitary pain, skin rash, nausea and vomiting.

- The treatment is mainly supportive, based on the hydration and varies according to symptoms and the severity of the case. Salicylates or non-steroidal anti-inflammatory agents must not be used.


- Prefeitura de Belo Horizonte. Protocolo para atendimento aos pacientes com suspeita de dengue – 2014. Gerência de Comunicação Social Secretaria Municipal de Saúde: Belo Horizonte, 2013.

- Costa AIP, Natal D. Distribuição espacial da dengue e deteminantes socioeconômicos em localidade urbana no sudeste do Brasil. Revista de Saúde Pública. 1998, 2(3):232-36.

- World Health Organization. Dengue Prevention and Control. Dengue Bulletin. 2002, vol 26:218-20.

- Rothman AL. Epidemiology of dengue virus infections. Waltham: UpToDate, 2013. [accessed in May 2014]. Available at:

- Rothman AL. Pathogenesis of dengue virus infection. Waltham: UpToDate, 2013. [accessed in May 2014]. Available at:


Marina Bernardes Leão, 5th year medical student at UFMG School of Medicine

E-mail: marinableao[at]


Prof Helena Duani, infectologist, professor of the Department of Clinical Medicine at UFMG School of Medicine

E-mail: hduani[at]


Janaína Chaves, Hércules Riani, Lucas Rodrigues, Letícia Horta, Ana Júlia Bicalho, Prof Viviane Parisotto

Translated by

Renato Gomes Campanati, 6th year medical student at UFMG School of Medicine

E-mail: campanati[at]


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