Dengue fever is a mosquito-bound viral illness that occurs in tropical climates. It is endemic in 110 countries.1 Fifty to three hundred and ninety million people are infected worldwide every year,2 leading to ~25,000 deaths.3 It is often an asymptomatic self-limited illness, which can present with myalgias, arthralgias, and hemorrhagic manifestations such as petechiae. In a fraction of cases, dengue fever can proceed to dengue hemorrhagic fever (DHF), which can be life threatening causing thrombocytopenia, bleeding and increased vascular permeability. Dengue shock syndrome (DSS) can then ensue, if hypotension occurs, and is fatal in >10% of patients.4

Here we present a case of Dengue fever, which proceeded to DHF and finally DSS. Our case demonstrates the supportive nature of treatment and how catastrophic severe dengue fever can be.