MENDEZ, Ángela    GONZALEZ, Gerardo. Manifestaciones clínicas inusuales del dengue hemorrágico en niños. []. , 26, 1, pp.61-70. ISSN 0120-4157.

^les^aIntroducción. Recientemente han venido aumentando los reportes de dengue hemorrágico con manifestaciones inusuales, principalmente neurológicas y hepáticas, que aumentan la morbimortalidad. Objetivo. Describir las manifestaciones inusuales del dengue hemorrágico en niños. Materiales y métodos. En el Departamento de Pediatría del Hospital Universitario de Santander en Bucaramanga, Colombia, de 913 pacientes con diagnóstico de dengue hemorrágico entre 1992 y 2004, se seleccionaron aquéllos que presentaron manifestaciones inusuales. Se clasificaron de acuerdo con los criterios de definición de caso, se agruparon según los órganos o sistemas principalmente comprometidos y se describieron los principales hallazgos clínicos, de laboratorio y relativos a la evolución. Resultados. Se encontraron 168 pacientes que presentaron manifestaciones inusuales, con predominio del sexo masculino, edad escolar y grados III y IV de dengue hemorrágico. Las manifestaciones más frecuentes fueron hepáticas, 53 (27%), y neurológicas, 49 (25%), además de renales, 14 (7%); cardíacas, 15 (8%); pulmonares, 18 (9%); colecistitis alitiásica, 18 (9%); síndrome hemofagocítico, 5 (2,5%); pancreatitis, 2 (1%), y 21 casos de abdomen agudo (11%). Fallecieron 10 pacientes. Conclusión. Se analizan los resultados y se comparan con otros de países endemoepidémicos de dengue; se discute el significado e importancia de las manifestaciones clínicas inusuales, su difícil diagnóstico, casi siempre en forma retrospectiva, y se destaca la frecuencia de las manifestaciones hepáticas y neurológicas que pueden aumentar la morbimortalidad, ante las cuales deben estar alertas los médicos que trabajan en zonas endémicas para reconocerlas.^len^aIntroduction. Recently, dengue hemorrhagic fever with unusual neurological and hepatic manifestations has been reported in children, with a concomitant increase in morbidity and mortality. Objective. To describe unusual clinical manifestations of dengue hemorrhagic fever in children. Materials and methods. These manifestations were systematically scrutinized in dengue cases occurring between 1992-2004 in the Pediatrics Department of the University Hospital of Santander, Bucaramanga, Colombia. Case reports were examined of 913 patients with clinical symptoms of dengue hemorrhagic fever. They were classified according to standard criteria for dengue hemorrhagic fever and grouped according to the main organs or systems that were affected. Clinical presentation, laboratory results and medical evolution were summarized. Results. Of the 913 cases, 168 showed abnormal clinical manifestations; these were predominant in male school age children and associated mainly with grades III and IV of dengue hemorrhagic fever. The most frequent manifestations were as follows: hepatitis-53 cases (27%), neurological alterations-49 (25%), renal impairment-14 (7%), cardiac involvement-15 (8%), pulmonary alterations-18 (9%), alithiasic cholecistitis-18 (9%), haemophagocitic syndrome-5 (2.5%), pancreatitis-2 (1%), and acute abdominal pain-21 (11%). Ten patients died. Conclusions. The results were compared with data from other endemoepidemic countries of dengue. The significance and importance of abnormal dengue were explored, as well as the difficult retrospective diagnoses. Hepatic and neurological manifestations were recognized as frequently involved in elevated morbidity and mortality.Physicians working in endemic zones should be aware of them in order to recognize them.

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