Severe neonatal dengue with confirmed vertical transmission of DENV-3: A fatal case from Honduras.

Dengue virus (DENV) infection is a major public health concern, with an estimated 390 million infections annually. Although typically self-limiting, dengue can progress to severe, life-threatening complications in high-risk groups such as neonates. Vertical transmission has been reported in up to 22.7 % of pregnancies complicated by maternal dengue. We report a fatal case of severe neonatal dengue due to DENV-3, confirmed by RT-PCR in both mother and infant. The neonate, born at 38 weeks of gestation via cesarean section to a mother with severe dengue and preeclampsia with severe features, complicated by HELLP syndrome, developed hemodynamic instability and died on day 11 of life. The mother also died shortly after delivery despite intensive management. This case highlights the diagnostic and therapeutic challenges of congenital dengue, especially in resource-limited settings. The presence of DENV-3 in both mother and neonate, with fatal outcomes in both, highlights the need for early recognition, timely intensive care, and further investigation into serotype-specific risks.