Dengue-Induced Adrenal Hemorrhage with Retinopathy and Hepatitis: A Case of Multisystem Involvement

A BSTRACT Background: Dengue-induced adrenal hemorrhage leading to acute adrenal insufficiency is an extremely rare but potentially life-threatening complication of dengue fever. The concurrent presentation with dengue retinopathy and hepatitis represents a unique pattern of multisystem involvement rarely reported in the literature. Case Presentation: A case of a 30-year-old male who had dengue hemorrhagic fever complicated by bilateral adrenal hemorrhage resulting in acute adrenal insufficiency secondary to adrenal hemorrhage was presented. The patient simultaneously developed rare dengue retinopathy with macular involvement and dengue hepatitis. Initial presentation included fever, abdominal pain, and visual symptoms. The adrenocorticotropic hormone (ACTH) stimulation test revealed persistently low serum cortisol levels (15.8 μg/dL), confirming adrenal insufficiency. Ophthalmological examination showed visual acuity of 6/18 OD and 6/36 OS with bilateral macular edema and multiple cotton wool spots. Laboratory investigations revealed severe thrombocytopenia (26,000/μL) and elevated transaminases, indicating hepatitis. Computed tomography (CT) of the abdomen showed unilateral adrenal enlargement consistent with hemorrhage. Serological tests confirmed dengue infection with positive IgM, IgG, and NS1 antigen. Outcome: The patient was managed with IV hydrocortisone therapy for adrenal insufficiency, showing marked improvement within 48 hours. Conservative management was employed for retinopathy and hepatitis. The patient achieved complete recovery of adrenal function, resolution of dengue retinopathy, normalization of liver enzymes, and was discharged in stable condition. Conclusion: This case highlights dengue-induced adrenal hemorrhage as a rare but serious complication requiring prompt recognition and corticosteroid replacement therapy. The concurrent presentation with dengue retinopathy and hepatitis emphasizes the potential for severe multisystem involvement in dengue infections. Early diagnosis and appropriate management are crucial for favorable outcomes.