Concurrent varicella and dengue infection in an adolescent female: diagnostic and clinical challenges in an endemic setting
5 affiliations
- 1Pediatric Infectious Disease and Tropical Medicine Department, San Lazaro Hospital, Manila, Philippines
- 2School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- 3San Lazaro Hospital-Nagasaki University Collaborative Research Office, San Lazaro Hospital, Manila, Philippines
- 4Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- 5Department of Clinical Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
Abstract
Background: Varicella-zoster virus (VZV) infection and dengue virus infection are common viral illnesses in tropical regions. However, concurrent infections are rarely reported and may present significant diagnostic challenges because of overlapping clinical manifestations, including fever, rash, and hematologic abnormalities.
Case presentation: We report a laboratory-confirmed co-infection with VZV and dengue virus in a previously healthy 17-year-old female patient from Quezon City, Philippines. She initially presented with a 3-day history of fever and a generalized pruritic vesicular rash and was treated for varicella with oral acyclovir. Despite antiviral therapy, persistent high-grade fever, epigastric abdominal pain, leukopenia (2.8 × 10⁹/l), and thrombocytopenia (85 × 10⁹/l) prompted further investigation on the fourth day of illness. Diagnostic testing confirmed acute dengue infection by positive nonstructural protein 1 antigen and dengue immunoglobulin M test results, while VZV polymerase chain reaction testing of vesicular fluid confirmed varicella. The patient received supportive dengue management alongside continued acyclovir therapy. Clinical symptoms improved, with resolution of fever by the sixth day of illness, normalization of hematologic parameters, and progressive crusting of lesions. She was discharged without complications.
Conclusions: This case highlights the importance of considering dengue co-infection in patients with apparent varicella who develop persistent fever, abdominal pain, leukopenia, or thrombocytopenia in dengue-endemic settings. Early laboratory confirmation is essential to distinguish overlapping clinical features, guide appropriate management, and prevent missed or delayed diagnoses.
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BibTeX
@article{gabot2026concurrent,
title = {{Concurrent varicella and dengue infection in an adolescent female: diagnostic and clinical challenges in an endemic setting}},
author = {John Kelvin S. Gabot and Ruth Faye R. Sengson and Chris Smith and Su Myat Han},
journal = {IJID Regions},
year = {2026},
month = sep,
doi = {10.1016/j.ijregi.2026.101026},
url = {https://doi.org/10.1016/j.ijregi.2026.101026},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Concurrent varicella and dengue infection in an adolescent female: diagnostic and clinical challenges in an endemic setting
AU - John Kelvin S. Gabot
AU - Ruth Faye R. Sengson
AU - Chris Smith
AU - Su Myat Han
PY - 2026
DA - 2026/09/25
JO - IJID Regions
DO - 10.1016/j.ijregi.2026.101026
UR - https://doi.org/10.1016/j.ijregi.2026.101026
AB - Background: Varicella-zoster virus (VZV) infection and dengue virus infection are common viral illnesses in tropical regions. However, concurrent infections are rarely reported and may present significant diagnostic challenges because of overlapping clinical manifestations, including fever, rash, and hematologic abnormalities. Case presentation: We report a laboratory-confirmed co-infection with VZV and dengue virus in a previously healthy 17-year-old female patient from Quezon City, Philippines. She initially presented with a 3-day history of fever and a generalized pruritic vesicular rash and was treated for varicella with oral acyclovir. Despite antiviral therapy, persistent high-grade fever, epigastric abdominal pain, leukopenia (2.8 × 10⁹/l), and thrombocytopenia (85 × 10⁹/l) prompted further investigation on the fourth day of illness. Diagnostic testing confirmed acute dengue infection by positive nonstructural protein 1 antigen and dengue immunoglobulin M test results, while VZV polymerase chain reaction testing of vesicular fluid confirmed varicella. The patient received supportive dengue management alongside continued acyclovir therapy. Clinical symptoms improved, with resolution of fever by the sixth day of illness, normalization of hematologic parameters, and progressive crusting of lesions. She was discharged without complications. Conclusions: This case highlights the importance of considering dengue co-infection in patients with apparent varicella who develop persistent fever, abdominal pain, leukopenia, or thrombocytopenia in dengue-endemic settings. Early laboratory confirmation is essential to distinguish overlapping clinical features, guide appropriate management, and prevent missed or delayed diagnoses.
SN - 2772-7076
ER -