A 28-year-old pregnant woman was admitted to the emergency department with a second pregnancy at 38 weeks of age and no previous medical history.
She presented fever (39.4°C), myalgias and headache of 48 h duration, so she was admitted for study and treatment.
On the third day he began with mucosal bleeding in venipuncture areas and progressive deterioration of general condition.
Twenty-four hours later an emergency cesarean section was performed due to acute fetal distress with severe postpartum metrorrhagia.
The mother received support treatment that required multiple blood transfusions.
She was admitted 72 hours after delivery.
The child was born at 38 weeks of gestational age, weighing 3900 g and Apgar score 4/4.
During hospitalization in the neonatal care unit, a mechanical ventilation support was required due to meconium aspiration syndrome and hypertension, and luminotherapy due to her illiteracy.
On the fifth day of life, the child began with fever (39°C), hepatomegaly and a generalized evanescent exanthema.
After 24 h, nasogastric and venopun bleedings were added.
The blood count showed 5800 white blood cells (lymphocytes 43%, segmented neutrophils 47%, monocytes 6%, basophils 4%), hematocrit 34%, hemoglobin 11.2 mg% and platelet count 13 000/mm3.
With presumptive diagnosis of sepsis he underwent hemocultive, urocultive and lumbar puncture.
Detection of IgM antibodies for dengue virus was also requested.
Antibiotics and blood and platelet transfusions were indicated.
Cultures for common germs were negative.
The laboratory reported IgM by ELISA positive for dengue.
To confirm the result, the sample was sent to the National Institute of Human Viral Diseases of Pergamino, who certified by serological tests of ELISA, neutralization and molecular detection of the viral genome (RT-PCRN), the serotype 1.
Oxygen was administered until 26 days of life.
Platelet counts returned to normal 7 days after symptom onset.
The clinical course was favorable and the patient was discharged after one month of life.
As a consequence of perinatal asphyxia related to the form of severe dengue in the mother, the child presented hypoxic-ischemic encephalopathy and respiratory sequelae.
Clinical and serological controls were performed at 8 and 13 months of life, with persistence of antidengue IgG antibody titers, which confirmed the diagnosis of congenital infection.
The serological results by ELISA showed high positive titers, with a PR of 1.92 and 1.37 for dengue at 8 and 13 months, respectively.
Currently, the child undergoes neurological stimulation and preventive respiratory treatment with inhaled corticosteroids, with good outcome.
