A complicated case of expanded dengue syndrome presenting with dengue hemorrhagic fever in a five year old.

Dengue fever is an endemic disease in Pakistan presenting with a spectrum of clinical manifestations, ranging from mild fever to severe complications such as life-threatening bleeding and even death. Expanded dengue syndrome is a less recognized and rarely reported manifestation of the viral illness. We report a complicated case of expanded dengue syndrome in a five-year-old female initially presenting with Dengue Hemorrhagic Fever and subsequently involving multiple systems during the course of illness. She developed acute acalculous cholecystitis, hand cellulitis, right pleural effusion, encephalitis and ultimately myocarditis during her sixteen days of hospital admission. Despite the severity of her condition she was discharged in a vitally stable condition. This case highlights the importance of thorough monitoring and clinical vigilance to ensure timely recognition and management of such rare presentations in dengue fever patients in order to overcome this diagnostic challenge.