When Hemorrhage Meets Ischemia: Cerebral Vasculitis in a Patient with Dengue and Malaria Co-infection

Abstract

Background: Stroke is one of the several neurologic complications of Dengue described in the literature. In this article we report a case of subarachnoid haemorrhage and ischaemic stroke due to cerebral vasculitis occurring simultaneously in an African patient with Dengue Haemorrhagic fever and malaria. Presentation of Case: We report the case of a 29-year-old female with a known history of patent ductus arteriosus who presented with fever, headaches, gingival bleeding, jaundice, and hepatomegaly. Laboratory investigations revealed a positive Dengue IgM serology, a positive malaria blood smear. Despite initiation of antimalarial treatment with intravenous artesunate, her headache persisted. A brain CT scan performed on day 3 of admission revealed a subarachnoid haemorrhage. On day 7, the patient developed sudden aphasia and left-sided hemiparesis. Repeat neuroimaging, including CT and MRI, revealed features of cerebral vasculitis and an ischemic stroke involving the left internal capsule. The patient was discharged after 4 days of rehabilitation planning for outpatient physiotherapy. This case highlights the rare but severe neurological complications of dengue and malaria co-infection, posing both a diagnostic and therapeutic challenge. Conclusion: This case highlights a challenging diagnostic dilemma, where overlapping hemorrhagic and ischemic manifestations in dengue and malaria co-infection delayed recognition of underlying cerebral vasculitis.