Background: Since its emergence in China, SARS-CoV-2 has infected more than 15.5 million people worldwide, including in regions where dengue virus (DENV) is hyperendemic such as Latin America and Southeast Asia, including Indonesia. Hence, anticipation for simultaneous infection by DENV and SARS-CoV-2 has been raised.
Case presentation: We describe a 68-year-old woman with diabetes mellitus type II who was admitted to the Tangerang District Hospital on 14 April 2020. She lived in a neighborhood where a few people were contracting dengue fever. She presented with five days of fever, malaise, anorexia, nausea, myalgia, and arthralgia. Hematology results revealed anemia, thrombocytopenia, normal leukocyte count, increased neutrophil proportion, and decreased lymphocyte proportion and absolute lymphocyte. Her chest X-ray showed right pericardial infiltrates. Although dengue was clinically suspected, as she met COVID-19 screening criteria, she was also tested for SARS-CoV-2 infection. The patient was treated with ceftriaxone, paracetamol, azithromycin, oseltamivir, and chloroquine. She was clinically improved four days later and was discharged from the hospital on 25 April 2020 after SARS-CoV-2 rRT-PCR was negative on two consecutive samples. Dengue was diagnosed retrospectively based on sero-conversion of dengue IgM and a very high dengue IgG index (Focus Diagnostics®, ELISA), and sero-conversion of dengue IgM and positive IgG (PanBio ®Dengue duo cassette), which was equivalent to high hemagglutination inhibition antibody titer found in secondary dengue infection.
Conclusion: The overlapping clinical presentations of COVID-19 and dengue; limited diagnostic capacity of laboratories in resource constrained settings; and complexities of interpreting results make identification of COVID-19 in the dengue endemic setting challenging. Clinicians in endemic areas must maintain a high index of suspicion for the possibility of COVID-19 coinfection with DENV and other tropical pathogens.