A 54-year-old man diagnosed with type 2 diabetes mellitus comes to our office. He reported a fever of 40ºC with chills and shivering, arthromyalgia and headache, for which he started treatment with paracetamol. The symptoms started 24 hours before his return to Spain. Three days later she presented a generalized maculopapular rash that evolved into more intense petechiae on the lower limbs. She presented blood tests with leukopenia with 3,200/mm3 and platelets 91,000/mm3 and severe elevation of aminotransferases. The thick blood drop, peripheral blood smear, PCR and malaria antigen are negative. What is the most likely diagnosis?
It is striking in this question that we are told that our patient has returned to Spain, but not from where (which could help us to make digressions about the possible cause). However, the description of the picture is very exhaustive as well as typical, so the question is easy. It is a disease that produces fever, arthralgias and a generalized exanthema with petechiae on the lower limbs. The CBC shows leukopenia accompanied by plateletopenia and elevated transaminases. Malaria has been ruled out as a possible cause. All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility), answer 3 correct.
Coronavirus infection.
Lymphocytic choriomeningitis.
Dengue.
Chikungunya virus infection.
Saint Louis encephalitis.
All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility),