When Obesity Masks Shock: A Case of Compensated Dengue Shock Syndrome in an Early Adolescent

Dengue fever remains a major public health problem in tropical and subtropical regions. The global incidence of dengue has markedly increased over the past two decades. Severe dengue is life-threatening complication of dengue infection and if it accompanied with shock condition known as Dengue Shock Syndrome (DSS). Mechanism of organ system in children and adipose tissue related to pro-inflammatory cytokines which has impact of pathological cytokines-storm in DSS that make worsening condition of obese children with dengue infection. Increased baseline blood volume and altered inflammatory responses may mask early signs of hypovolemia, leading to delayed recognition of shock. To report a case of compensated DSS in early adolescent with obesity. We report the case of a 13-year-old obese pediatric patient with a body mass index of 38.9 kg/m2 who developed a compensated condition of dengue shock syndrome. Physical investigations showed indications of shock condition can be seen from the blood pressure at 110/90 mmHg and oliguria in 18 hours after admission, that successfully compensated after rehydration. Living in endemic area, fever, acute abdominal pain, petechiae, leukopenia, increase of hematocrit, thrombocytopenia and shock condition supported indications of severe dengue. Initially the patient was treated in the ward, but due to fast worsening condition, the patient was moved to the Pediatric Intensive Care Unit. After got treatment of severe dengue, the shock resolved and patient’s condition improved. Obesity mask early clinical manifestations of dengue shock syndrome, leading to delayed recognition of severe dengue. Strict monitoring is important to prevent worsening condition. Fast and precise management can reduce morbidity and mortality of severe dengue in children with obesity.