The Many Faces of Expanded Dengue Syndrome: A Two-Case Series of Renal and Hepatic–Neurological Organ Involvement in Adult Patients

Abstract

Introduction: The rising global incidence of dengue has been accompanied by increasing recognition of atypical, organ-dominant presentations collectively termed expanded dengue syndrome (EDS), in which severe involvement of the liver, kidney, heart, lung or central nervous system dominates the clinical picture and drives mortality. We describe two adult men who illustrate contrasting EDS phenotypes.

Case presentation: Case I, a 30-year-old man with serologically confirmed secondary dengue infection (IgM-negative, IgG-positive), presented with gross haematuria, dysuria and warning signs and developed acute kidney injury (oliguria, rising creatinine, proteinuria, marked erythrocyturia) superimposed on leucopenia, severe thrombocytopenia and haemoconcentration; he recovered fully with carefully titrated crystalloid and renoprotective measures. Case II, a 23-year-old man with a primary infection, deteriorated on the sixth day with agitated delirium and acute liver failure (transaminases exceeding 100 times the upper limit, hyperbilirubinaemia, coagulopathy, hypoalbuminaemia) complicated by hepatic encephalopathy; he improved with supportive care, electrolyte correction and multidisciplinary management.

Conclusion: EDS may arise from either secondary or primary infection, and organ dysfunction tends to resolve in step with the natural history of dengue. Meticulous fluid stewardship stratified by clinical group, with systematic evaluation for intensive-care needs using clinical, laboratory and imaging parameters, is the cornerstone of management. Early recognition of organ-specific complications is essential to reduce preventable morbidity and mortality.