Psychiatric manifestations as the leading symptom in an expatriate with dengue fever

Excerpt

A 52-year-old Swiss female patient suffered from intermittent fever up to 39°C, headache, moderate diarrhea and dizziness within 2 months after arriving in Haiti where she worked for a non-governmental organization. She collapsed three times but regained consciousness immediately after being placed in a lying position. Although the patient interpreted these events as resulting from a mild flu-like illness combined with orthostatic collapse, she was hospitalized 3 days later to rule out underlying cardiac disease. The initial clinical examination showed hypotension (blood pressure 80/60 mmHg), bradycardia (pulse rate 40 beats per minute) and severe fatigue (Fatigue Severity Score 6–7). The day following her admission to hospital, she developed a psychiatric syndrome characterized by the following symptoms: ideas of reference and delusions with vivid acoustic and visual hallucinations, accompanied by agitation and psychotic fears. She had the impression that part of the staff was trying to harm her, as she heard voices denouncing her from people close to a (non-existent) swimming pool. She also had the impression that there was writing on the bed linen, red in color, and that this writing was a list of judgmental comments on her (mis)behavior. To counteract this “judgments”, she tore the linen and began to write her “defense” on the linen using a pen with black ink. The intravenous drip intended to rehydrate the patient was another object of psychotic fears: she hallucinated embryos in the saline solution and therefore tried to tear out the drip. During the night she suffered from nightmares in which she mixed childhood experiences with the grim reality of poverty in Haiti. All of these hallucinations resulted in a fluctuating emotional state that ranged from fear and sadness to anger and a call to action. When addressed by her husband and staff, she was able to answer simple questions, and she did not refuse eating and drinking. Fever was not a leading symptom during the hospitalization period, and it subsided after a few days. …