A report describes a case of a 19-year-old male patient who presented with a fever of 4 days with chills, body aches, and anorexia during the dengue epidemic. He did not complain of joint pains or rash; or gave any history of dysuria, altered bowel movement, cough or coryza. 

On examination, the patient was febrile, with stable vitals, and no active bleeding manifestations. General physical examination was unremarkable with no organomegaly. 

Preliminary investigations showed thrombocytopenia [87000/mm3] and leucopenia [3700/mm3]. Thus, a presumptive diagnosis of dengue was given and prescribed antipyretics, optimum hydration, and rest. 

He tested negative for malaria but positive for Dengue NS1 antigen and IgM dengue serology (after 7 days). Over 7 days, he showed an improvement in the platelet count and leucocyte count. His fever persisted even after 7 days of the illness, while myalgia, fatigue and appetite improved. Thus other etiologies for fever were explored. 

The urine examination and chest x-ray were normal. The work-up for enteric fever and malaria was negative. Blood culture was also negative.

Routine biochemistry including liver and kidney function tests was normal. His tests for Chikungunya and scrub typhus were also negative. The fever remained 101 F to 102 F after 7 days, as compared to 104 F on presentation, and touched baseline with antipyretics, which reappeared after 4 to 6 hours. This fever pattern persisted for 14 days but decreased to 100 F on day 15. On the 16th day, the patient became afebrile. During these 15 days, the patient stayed on antipyretics and supportive treatment only. After 3 days of an afebrile period, he was discharged and was followed up after 1 week to find him asymptomatic.

Bansal P. Dengue Fever with Prolonged Recovery - Case Report. Ann Vaccines Immunization. 2017;3(1): 1014.