Case report
The exanthem of dengue fever: Clinical features of two US tourists traveling abroad

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Background

Dengue fever is the most common identifiable cause of acute febrile illness among travelers returning from South America, South Central Asia, Southeast Asia, and the Caribbean. Although the characteristic exanthem of dengue fever occurs in up to 50% of patients, few descriptions of it are found in the dermatology literature, and discussions of how to distinguish the dengue exanthem from other infectious disease entities are rare. Chikungunya fever is an emerging infectious disease now seen in returning US tourists and should be considered in the differential diagnosis of dengue fever in the appropriate patient.

Objective

The purpose of our study was to report two cases of dengue fever among returning US tourists, provide a review of dengue fever, offer an extensive differential diagnosis of dengue fever, and raise awareness among dermatologists of chikungunya fever.

Methods

This study includes clinical findings of two returning travelers, one who traveled to Mexico and the other to Thailand, complemented by a discussion of both dengue fever and its differential diagnosis.

Limitations

Limited to 2 case reports.

Conclusion

Dengue fever should be considered in the differential diagnosis of fever and rash in the returning traveler. Dermatologists should be aware of the distinctive exanthem of dengue fever. Recognition of the dengue fever rash permits a rapid and early diagnosis, which is critical, as dengue fever can progress to life-threatening dengue hemorrhagic fever or dengue shock syndrome.

Section snippets

Case 1

A previously healthy 32-year-old woman from San Francisco, Calif, developed headache, fever, extreme fatigue, and a flushing macular erythema over the chest 2 days after returning from a vacation in Central Mexico. Three days later, she developed a generalized morbilliform eruption studded with pinpoint petechiae and islands of sparing.

Initial laboratory evaluations indicated a white blood cell count of 1.5 × 109/L (normal 3.4-10 × 109/L), a hematocrit of 48.9% (normal 36%-46%), a platelet

Case 2

A previously healthy 21-year-old female college student presented to a hospital in New York City with a generalized rash 2 days after returning to the United States after spending 1 month in Thailand. Two days before returning to the United States, she developed the sudden onset of high fever, myalgias, and severe fatigue. On examination, she had a diffuse morbilliform eruption with petechiae and islands of sparing (Fig 1). When she first developed symptoms in Thailand, she thought she had

Discussion

Dengue virus, of the family Flaviviridae, is a single-stranded RNA virus transmitted by the mosquitoes Aedes aegypti and Aedes albopictus. There are 4 serotypes of the dengue virus (DEN 1-4). Infection with one strain provides lifelong immunity to that strain, but only a few months of immunity to other strains.

Infection with the dengue virus can cause a spectrum of 3 clinical syndromes: classic dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. World Health Organization criteria

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    Funding sources: None.

    Conflicts of interest: None declared.

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