A report describes a case of a 37-year-old non-Saudi man who was referred to the secondary-level hospital with a preliminary diagnosis of dengue fever. He presented with complaints of fever, nausea, vomiting, body ache, dry cough, and abdominal pain for five days. 

His blood examination showed leucopenia (3,500 per cu. mm) and thrombocytopenia (109 × 103/mm3), and urine analysis revealed glycosuria and ketone-positive, and 293 mg/dl RBS. 

The patient rendered a history of diabetes mellitus.

A general examination revealed him to be normotensive, febrile at 39°C, and his pulse was 90/min. Abdominal examination showed tender epigastrium. Chest examination showed bilateral rhonchi. Chest X-ray revealed right-sided basal pneumonia. The patient was suspected of COVID-19 and dengue and was shifted to an isolation room. His RT-PCR for COVID-19 infection and dengue PCR both came positive, confirming the co-infection.

The patient received the treatment as per the Ministry of Health (MOH) guidelines for COVID-19, which included antibiotics, anticoagulants, oxygen, corticosteroids, and an immunomodulator during his stay in the hospital. His oxygen saturation was 97% on room air with no dyspnoea. 

The patient continued with medical treatment, but on the 9th day of his admission, he developed a disturbed consciousness, marked respiratory distress, increased blood glucose level, sugar and ketones in the urine, and metabolic acidosis, thus was shifted to ICU on high-flow oxygen, IV fluids, and IV insulin. His CT brain revealed a normal result.

The patient started desaturation and was connected to a non-invasive mechanical ventilator. His BP was 130/70 mmHg, tachycardia 140 b/min, and tachypnoea 50/min. His condition started deteriorating in the ICU with a Glasgow Coma Scale (GCS) scale of 10/15 and electrolyte Imbalance, hypernatremia, and hypokalaemia. On the 5th day of his ICU stay, he showed signs of improvement, with improvement in the level of consciousness, and 13/15 GCS, BP 120/70 mmHg, RR 30/min, O2 saturation 94%, temp 37.5. Besides improvement in all parameters, there was a decrease in platelets, which reached 20,400 on day 11 of the intensive care unit (ICU) stay even after a transfusion of platelets (6 units). On day 13 of his ICU stay, he again showed a decreased level of consciousness and was desaturated on a non-invasive mechanical ventilator, intubated, and put on a mechanical ventilator. ABG revealed severe metabolic and respiratory acidosis and high troponin, D dimer, and pro-BNP. The patient developed Brady-systole, did not respond to CPR as per ALS protocol, and expired.

Al-Nazawi AM, Al-Zahrani AA, Qadir A, Alghamdi R, Tambo E, Alsahafi A. 

Case report: A fatal outcome from co-infection of COVID-19 and dengue in the western region of Jeddah, Saudi Arabia. Frontiers in Public Health. 2022;10. DOI: 10.3389/fpubh.2022.942381