Dengue virus infection presenting with diffuse brain hemorrhage.

A 40-year-old woman presented to the emergency department with acute decreased level of consciousness, associated with respiratory failure. She has complained of headache, fever, myalgia and dyspnea for the last seven days. Neurological examination disclosed decreased level of consciousness. Brain CT scan disclosed multiple intracerebral acute hemorrhage lesions (Figure). After extensive investigation, serologic test confirmed Dengue virus infection. Brain involvement in dengue virus infection may have variable presentation, and encephalitis is the most common. However, although unusual, patients may present with cerebral hemorrhage, particularly in hemorrhagic dengue. Pathophysiology may include: capillary hemorrhage, disseminated intravascular coagulation and cerebral edema.