Dengue Hemorrhagic Fever with Fulminant Hepatic Failure in an Immigrant Returning

An immigrant from Bangladesh living in the United Kingdom presented with a nonspecific febrile illness after visiting his homeland and subsequently developed fulminant hepatic failure accompanied by hypotension, ascites, a generalized coagulopathy, and thrombocytopenia. Serology and detection of dengue virus serotype 3 by PCR established a postmortem diagnosis of hepatic failure secondary to dengue hemorrhagic fever. Dengue viral infections are transmitted by the Aedes aegypti mosquito and affect up to 100 million individ-uals per year with two-fifths of the world population being at risk [1, 2]. The presentation of dengue infec-tion can be classified into 5 main forms: nonspecific febrile illness, classic dengue fever (DF), dengue hem-orrhagic fever (DHF), DHF with dengue shock syn-drome (DSS), and unusual syndromes such as enceph-alopathy [2]. All 4 serotypes of dengue virus can cause DHF, but this is more likely to occur with secondary infections with a different serotype [1, 2]. Although th