A Nearly Fatal Case of Expanded Dengue Syndrome in an Infant: Complex Challenges of Severe Hemorrhage, DIC and Multi-Organ Involvement

Abstract

A 1-year-old infant with Expanded Dengue Syndrome (EDS)—a severe dengue complication marked by multi-organ dysfunction—exhibited fever, vomiting, diarrhea, petechiae, palpebral edema, and cold extremities, progressing to disseminated intravascular coagulation (DIC), hepatic failure, and severe anemia. Laboratory findings confirmed thrombocytopenia, coagulopathy and acute liver injury. Management involved intensive resuscitation with crystalloids, colloids, packed red blood cells, fresh frozen plasma, and platelet transfusions, alongside vitamin K administration. Despite hemodynamic instability and severe bleeding, timely interventions enabled recovery.

Uncommon manifestations like palpebral edema and limb discoloration expanded the recognized EDS spectrum. This case underscores the critical need for early recognition of atypical symptoms, aggressive fluid optimization, and prompt transfusion strategies in endemic regions. Enhanced clinician awareness of EDS’s diverse presentations is vital to improving outcomes in pediatric dengue, where rapid deterioration necessitates vigilant monitoring and multidisciplinary care.