Case Report: A 33-year-old primigravida at 36 weeks of pregnancy presented with lower abdominal pain, vaginal bleeding, fever for four days, vomiting and reduced fetal movements for two days. She was pale, tachycardic, hypotensive, febrile, tense uterus and pooling of blood in the vagina. Fetal death was confirmed.

Eight hours after induction of labour, she delivered a normally formed stillborn baby weighing 3 kg. There was massive obstetric haemorrhage with retroplacental clots. Her Hb was 4.3 with disseminated intravascular coagulation which was then corrected with blood products. Following this episode, she had severe hypertension, requiring antihypertensive treatment and significant proteinuria.

Further investigations revealed Acute Kidney Injury, and dengue serology noted IgM positive

Peripheral blood film showed no evidence of hemolysis. She was seen by the Internal Disease team and was managed as Dengue Fever in pregnancy. Subsequently she recovered well and was discharged home.

Discussion: There have been reports that dengue fever in pregnancy, especially haemorrhagic dengue, mimics that of pre-eclampsia. In both conditions, there can be severe loss of fluid from vascular compartment and increased sequestration and consumption of platelets. Some have reported congenital dengue in up to 10% of neonates. However, abruption and intrauterine death during the febrile phase of dengue fever has never been reported. We report an unusual presentation with maternal dengue fever, stillbirth, followed by proteinuric hypertension and haemolytic uremic syndrome.

It is difficult to differentiate between severe haemorrhagic dengue from pre-eclampsia as they share similar features. It is more likely that this patient had severe pre-eclampsia with dengue fever. However the frequent reports of dengue fever with pre-eclampsia raises the suspicion that dengue fever may be a precipitator of pre-eclampsia.