Unilateral Vocal Cord Paresis in Dengue Hemorrhagic Fever: A Rare Delayed Immune-mediated Neurological Manifestation and Complete Recovery

and liver function tests were normal.On day 7, a vasovagal attack caused a fall, abdominal trauma, unconsciousness, transiently unrecordable blood pressure, and two further seizures.Admitted to the ICU with dengue shock syndrome and traumatic liver injury, significant initial abnormalities included a hemoglobin drop (7.4 gm/dL), thrombocytopenia, elevated transaminases, and reduced albumin.Glucose, creatinine, electrolytes, calcium, and IntroductIonDengue virus is transmitted primarily by Aedes aegypti and Aedes albopictus mosquitoes.It is endemic in more than 100 countries, affecting 14.6 million people in 2024. 1 In Bangladesh, the disease has escalated into a severe public health threat.According to the Directorate General of Health Services (DGHS), Bangladesh experienced a massive outbreak in 2025 with 102,861 cases and 413 deaths, 2 highlighting the urgent need to understand the virus's evolving clinical presentations.Dengue causes classic dengue fever (DF) and severe dengue hemorrhagic fever (DHF), typically presenting with fever, shock, hepatitis, bleeding, and abdominal pain.Diverse neurological manifestations are increasingly recognized, occurring in approximately 5% of patients.Pathophysiological mechanisms likely involve direct central nervous system (CNS) viral invasion, systemic metabolic alterations, or postinfectious autoimmune reactions.3 Here, we discuss a rare case of a DHF patient admitted to the intensive care unit (ICU) with dengue shock syndrome on day 7 of fever, who developed left vocal cord palsy on day 14 followed by spontaneous recovery.This highlights the potential for delayed, immune-mediated peripheral nervous system complications in dengue patients. case descrIptIonAn 18-year-old female presented with a 6-day history of fever, one afebrile day, and two episodes of generalized tonic-clonic seizures.She was diagnosed with dengue based on NS1 positivity on day 1; her initial complete blood count (hemoglobin: 8.9 gm/dl)