Ref Number = PITIKA-ASPR0132
Nada Ardilla Dwiayu Febrina, Zulmansyah
BACKGROUND. Expanded Dengue Syndrome (EDS) is an atypical manifestations of dengue infection affecting various organ system including gastrointestinal (GI), hepatic, neurological, cardiac, pulmonary, and renal. It become one of the leading causes of hospitalization and death in children. Severe case can present with petechiae, epistaxis, GI bleeding, ascites, pleural effusion, heart attack, hypotension, tachycardia, low of consciousness, fulminant hepatitis, myocardiopathy, and encephalitis.

OBJECTIVE. To show the spectrum of dengue infection especially EDS. And should be monitored to reduce the morbidity and mortality of these cases.

CASE. A 10-months-old baby girl, came to emergency room with high fever since 4 days before admission. High fever was accompanied by vomit, diarrhea. From the physical examination, general condition was compos mentis, pulse and respiration within normal limit. There was no epistaxis. Laboratory showed platelet 100,000µ/L, hematocrit 35,5%, hemoglobin (Hb) 12,3g/dL. Patient was diagnosed with dengue hemorrhagic fever. Patient was given ringer lactate infusion and antipyretic. After 2 days of hospitalization, condition worsened with the onset of seizure and low of consciousness. Oxygen therapy and Diazepam injection was given. An hour later, the patient had dyspnea. Laboratory showed platelet 29,000µ/L. Patient was somnolence. There was respiratory nostril and restraction of the intercostal. Intravenous (IV) fluid was replaced with Gelofusin and given Dexamethasone injection therapy. Six hours later, there was melena and low of Hb level (6,6g/dL). Patient was sopor and desaturated. She had two IV line installed for blood transfusion. Patient was apnea one hour later and died.

CONCLUSION. The low incidence of EDS is because it’s asymptomatic and diagnosis is easily missed. This case have neurological manifestation such as seizure and low of consciousness, GI manifestation such as ascites and GI bleeding, pulmonary manifestation such as dyspnea. Condition worsened in a rapid time.
Keywords: Expanded dengue syndrome, Atypical manifestation of dengue, somnolence, GI bleeding, apnea
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