Table 3.

Atypical manifestations of expanded dengue syndrome

System	Manifestations
Neurological involvement	Neurological involvement seizures, encephalopathy, Encephalitis/aseptic meningitis, intracranial hemorrhages/thrombosis, subdural effusions, Mononeuropathies/polyneuropathies/Guillain-Barre syndrome, transverse myelitis, papilledema, myoclonus, pyramidal signs, myelitis, acute motor weakness, neuritis, hypokalemic paralysis, cranial nerve palsy
Gastrointestinal/hepatic involvement	Hepatomegaly, hepatitis/fulminant hepatic failure, hepatic encephalopathy, acalculous cholecystitis, acute pancreatitis, hyperplasia of Peyer’s patches, acute parotitis, moderate ascites, acute inflammatory colitis and gastric hemorrhage
Renal involvement	Hematuria. Acute renal failure, Hemolytic uremic syndrome
Cardiac involvement	Myocarditis, pericarditis, cardiogenic shock, pulmonary edema, bradyarrhythmia (severe sinus bradycardia), heart block, tachyarrhythmia - atrial fibrillation, acute reversible cardiac insult, sinoatrial block, and atrioventricular dissociation
Respiratory involvement	Acute respiratory distress syndrome, pulmonary hemorrhage
Musculoskeletal involvement	Myositis, rhabdomyolysis, polyarthritis, postinfectious fatigue syndrome
Lymphoreticular/bone marrow involvement	IAHS or HLH, ITP, spontaneous splenic rupture, lymph node infarction
Ophthalmic involvement	Impaired visual acuity, Macular hemorrhage, Optic neuritis, uveitis
Psychological involvement	Depression, hallucinations, psychosis
Vasculitis/immunological involvement	Systemic lupus erythematosus, Kawasaki disease in the young child
Dermatological involvement	Maculopapular/morbilliform eruption followed by ecchymotic, petechial, and macular/scarlatiniform eruption, confluent erythema, morbilliform eruptions, and hemorrhagic lesions, alopecia
Hematological/coagulation disorder	Bone marrow hemophagocytosis associated with nasal bleeding (epistaxis), pancytopenia, DIC
Oxidative stress	Increase in oxidative stress significantly elevated PCOS and low PBSH group levels

HLH: Hemophagocytic lymphohistiocytosis, IAHS: Infection associated hemophagocytic syndrome, DIC: Disseminated intravascular coagulation, PBSH: Protein-bound sulfhydryl group, PCOS: Protein carbonyls, ITP: Idiopathic thrombocytopenic purpura