Abstract
Background: Dengue is a major cause of paediatric hospitalization in endemic regions, presenting with atypical organ-specific complications that are easily overlooked. This series describes children with dengue and uncommon cardiac, neurological, and hepatobiliary involvement managed in a tertiary paediatric intensive care unit.
Case presentation: 11 children with serologically confirmed dengue infection were admitted to PICU of Narayana Health City, Bengaluru, during August–October 2024. The cohort manifested life-threatening complications, including myocarditis with cardiogenic shock requiring inotropes, levosimendan, and, in one case, VAECMO, ANEC; and hepatobiliary dysfunction with features suggestive of secondary HLH. All patients received protocol-based dengue management, individualized organ support, and, where indicated, immunomodulatory therapy with corticosteroids, IVIG, and biologic agents such as Anakinra. 3 had single-organ involvement, while others showed multisystem disease with significant plasma leakage. 7 out of 11 children to hospital discharge with some requiring prolonged ICU care.
Conclusions: Atypical manifestations of dengue involving the heart, liver, and central nervous system are not uncommon. Early recognition, appropriate referral to intensive care, meticulous fluid and haemodynamic management, and judicious use of immunomodulation are essential to improving outcomes in such cases.
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