Unusual clinical manifestations of dengue disease - Real or imagined?

The disease caused by each of the four serotypes of dengue virus (DENV) have plagued humans since last century. Symptoms of dengue virus (DENV) infection range from asymptomatic to dengue fever (DF) to severe dengue disease (SDD). One third of the world's population lives in regions with active urban DENV transmission, and thousands of serologically naïve travelers visit these areas annually, making a significant portion of the human population at risk of being infected. Even though lifelong immunity to the homotypic serotype is achieved after a primary DENV infection. Heterotypic DENV infections may be exacerbated by a pre-existing immune memory to the primary infection and can result in an increased probability of severe disease. Not only, age, comorbidities and presence of antibodies transferred passively from dengue-immune mother to infants are considered risk factors to dengue severe forms. Plasma leakage and multiple organ impairment are well documented in the literature, affecting liver, lung, brain, muscle, and kidney. However, unusual manifestation, severe or not, have been reported and may require medical attention. This review will summarize and discuss the increasing reports of unusual manifestations in the clinical course of dengue infection.

High-risk human papillomaviruses in two different primary tumors in the same patient.

Two cases of patients with high-risk human papillomavirus-related squamous cell carcinomas of the penis are reported. In both patients, a second high-risk human papillomavirus-related squamous cell carcinoma, of the same type (genotype 16), was detected: a carcinoma of the oropharynx 2 years after treatment of the squamous cell carcinomas of the penis in the first patient, and a carcinoma of the esophagus 1 year after the treatment of the squamous cell carcinomas of the penis in the second patient. To the best of our knowledge, this is the first time that multiple human papillomavirus-related tumors in the same patient are reported. It is suggested that a careful clinical investigation is necessary in patients with tumors attributable to high-risk human papillomavirus for the early detection of a possible second neoplasm related to this virus in a different organ.