Islands of White in a Sea of Red: A Cutaneous Manifestation of Dengue Fever in a Pregnant Woman

Abstract

Dengue fever is a significant public health problem in Asia, resulting in serious morbidity and even mortality. It is mainly known for causing severe constitutional symptoms and bleeding, often resulting in haemorrhagic shock. Dengue fever may manifest cutaneously in several forms. These include petechial rash, maculopapular rash and what has been termed as islands of white in a sea of red. Most can be attributed to capillary fragility, which led to tests such as the tourniquet test. This case highlights the dengue fever cutaneous presentation of islands of white in a sea of red in a multigravida woman during her first trimester. Her husband and son who was infected at the same time did not develop similar skin condition but developed the more common maculopapular and petechial rashes. The pathophysiology of such lesions is not well understood, and its relation to pregnancy is not known. Blood investigations were typical of dengue fever. The outcome of the patient’s pregnancy was also normal. This case highlights the need for doctors to look out for such lesions in dengue patients.