A 1-year-old boy infant presented with fever for 3 days. On
examination he was febrile and his face, trunk and
extremities were erythematous which blanched upon pressure (Fig.
1). His platelet count dropped to 83,000 per µL on day 5
of illness. His dengue serology IgM was positive suggestive
of primary dengue infection.
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Fig. 1 Febrile rash of
dengue which blanches upon pressure.
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A 9-year-old girl presented with fever
for 4 days. On day 8 of illness, when her fever subsided,
she developed hypotension. Her platelet count dropped to
15000/ml and hematocrit increased to 42.8%. She was
resuscitated with fluid boluses. She developed typical
dengue rash of convalescence 3 days after defervescence (Fig.
2). Her dengue serology IgM and IgG were positive,
suggestive of secondary dengue infection.
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Fig. 2 Convalescent rash of
dengue – "White isles in the sea of red".
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During the first 24-48 hours of fever,
children with dengue fever may develop a transient
generalized macular erythematous rash which blanches upon
pressure. The convalescent rash of dengue fever appears
about 2-3 days after defervescence. It is characterized by
generalized confluent petechial rash which does not blanch
upon pressure, with multiple small round islets of normal
skin. It is otherwise called "white is lands in a sea of
red". Some children with this rash may experience
generalized pruritus. This rash gradually fades over one
week.
