Severe Dengue or Covid-19 Related MIS-C? Diagnostic Challenges in Resource-Limited and Dengue-Endemic Regions


  • Angelina Fakultas Kedokteran Universitas Pelita Harapan
  • Arfianti Chandra Dewi Rumah Sakit Umum Balaraja, Tangerang, Indonesia



dengue, MIS-C, SARS-CoV-2, COVID-19, children


Besides serological cross-reactivity and co-infection between dengue and SARS-CoV-2, diagnostic challenges arise because many people have had positive dengue IgG in dengue-endemic regions, and patients usually come after 4-5 days of fever. We report a case of 9-year-old girl, diagnosed with dengue with warning signs on admission because of fever, severe abdominal pain, thrombocytopenia, and positive dengue IgG. The subsequent course of the illness was not consistent with dengue infection because the shock happened during the febrile phase concurrent with rising leucocyte and platelet counts, the fever continued for longer than seven days, and there was bilateral non-purulent conjunctivitis with subconjunctival hemorrhage. She was diagnosed with MIS-C because of positive SARS-CoV-2 IgG and hyperinflammatory markers. Her clinical condition improved progressively after steroid administration. Clinical awareness about MIS-C is required to avoid misdiagnosis and improper treatment during or after the COVID-19 pandemic. Every clinician should consider MIS-C as a differential diagnosis if patients have inconsistencies with the course of dengue illness.


World Health Organization. WHO Coronavirus (COVID-19) Dashboard [Internet]. 2021 [cited 2021 August 12]. Available from:

Peta Sebaran COVID-19 [Internet]. 2021 [cited 2021 August 12]. Available from:

Hasan MR, Zubaidi KA, Diab K, Hejazi Y, Bout-Tabaku S, Al-Abda B. COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a case series from tertiary care pediatric hospitalin Qatar. BMC Pediatr. 2012;21(267):1-9.

Alam A, Sudarwati S, Hakim DDL, Mahdiani S. Case report: severe COVID-19 and dengue in an Indonesian infant. Am J Trop Med Hyg. 2021;104(4):1456-60.

Tiwari L, Shekhar S, Bansal A, Kumar P. COVID-19 with dengue shock syndrome in a child: coinfection or cross-reactivity? BMJ Case Rep. 2020;13:e239315.

Masyeni S, Santoso MS, Widyaningsih PD, Asmara DGW, Nainu F, Harapan H, et al. Serological cross-reaction and coinfection of dengue and COVID-19 in Asia: Experience from Indonesia. Int J Infect Dis. 2021;102:152-4.

Utama IMS, Lukman N, Sukmawati DD, Alisjahbana B, Alam A, Murniati D, et al. Dengue viral infection in Indonesia: Epidemiolgy, diagnostic challenges, and mutations from an observational cohort study. PLoS Negl Trop Dis. 2019;13(10):e0007785. doi: 10.1371/journal.pntd.0007785.

Ratageri VH, Pawar GR, Nikhil G, George SS. Co-infection of dengue fever with COVID-19 in a child with MIS-C. Indian J Pediatr. 2021;88(5):485.

Kembuan GJ. Dengue serology in Indonesian COVID-19 patients: coinfection or serological overlap? IDCases. 2020;22:e00927.

Khairunisa SQ, Amarullah IH, Churrotin S, Fitria AL, Amin M, Lusida MI, et al. Potential misdiagnosis between COVID-19 and dengue infection using rapid serological test. Infect Dis Rep. 2021;13:540-51.

World Health Organization. Handbook for clinical management of dengue. Geneva: WHO Press; 2012.

Suleman M, Faryal R, Alam MM, Sharif S, Shaukat S, Aamir UB, et al. NS1 antigen: a new beam light in the early diagnosis of dengue infection. Asian Pac J Trop Med. 2016;9(12):1212-14.

Mohamed NA, El-Raoof EA, Ibraheem HA. Respiratory manifestations of dengue fever in Taiz-Yemen. Egypt J Chest Dis Tuber. 2013;62:319-23.

Handayani I, Indrati AR, Alam A. Clinical and laboratory profile of infant dengue at RSUP Dr Hasan Sadikin Bandung. Sari Pediatri. 2017;19(3):119-26.

Somkijungroj T, Kongwattaananon W. Ocular manifestation of dengue. Curr Opin Ophthalmol. 2019;30:500-505.

Hoste L, Pamel LV, Haerynck F. Multisystem inflammatory syndrome in children related to COVID-19. Eur J Pediatr. 2021;108(7):2019-34.

Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020;383(4):334–46.

Payne AB, Gilani Z, Godfred-Cato S, Belay ED, Feldstein LR, Patel MM, et al. Incidence of Multisystem Inflammatory Syndrome in Children Among US Persons Infected With SARS-CoV-2. JAMA Netw Open. 2021;1:4(6):e2116420.




How to Cite

Angelina, & Dewi, A. C. (2023). Severe Dengue or Covid-19 Related MIS-C? Diagnostic Challenges in Resource-Limited and Dengue-Endemic Regions. Jurnal Profesi Medika : Jurnal Kedokteran Dan Kesehatan, 17(1).