Dengue with a morbilliform rash and a positive tourniquet test

CASE REPORT A 28-year-old Connecticut woman had fever and rash 3 days after returning from the Dominican Republic. During her trip, she ate the food, drank the water, and suffered many mosquito bites. The rash involved her neck, chest, and extremities. Accompanying the rash, she had chills, fever, headache, and malaise. She had no arthralgias, myalgias, or diarrhea. During childhood, she immigrated to the United States from the Dominican Republic. Routine immunizations were up to date including 2 measles, mumps, and rubella vaccinations. She had no pretravel medical visit. She was seen on day 4 of her illness. She was in no distress and had a morbilliform rash on her head, neck, trunk, and extremities. Her hemoglobin level was 14.8 g/dL, white blood cell count was 4,200/ mm, and platelet count was 133,000/UL. Results of a malaria thin smear were negative. During our patient’s visit to the Dominican Republic, there was a dengue outbreak. This information prompted the resident to do the tourniquet test, which was positive (Fig 1). The illness was mild, and only acetaminophen was recommended. The patient’s rash, headache, chills, and malaise resolved spontaneously over the next week and she remained well. Dengue was confirmed serologically—acute dengue serology was IgM positive, and there was a greater than 4-fold increase between acute and convalescent IgG antibodies.