The patient is a 50-year-old woman who is an occasional smoker. Her personal history of interest included a nine-day tourist trip to the Mayan Riviera (Mexican Caribbean), fifteen days before the onset of symptoms. During the trip, the patient reported numerous mosquito bites. In the 48 hours prior to consultation, the patient self-treated with acetylsalicylic acid (ASA) as an antipyretic and symptomatic treatment for headache.
On physical examination the patient was conscious, oriented and febrile (37.6ºC), BP=110/70. There was facial flushing and bilateral conjunctival injection as well as the presence of a haemorrhagic, symmetrical, maculo-papular rash on the trunk and extremities, especially on the lower limbs, where it was confluent, and which did not change on vitropressure. In the rest of the examination by apparatus, only the presence of numerous latero- and retrocervical adenopathies and preauricular adenopathies was identified. There was no evidence of meningismus or hepatosplenomegaly.

The Rumpell-Leade loop test showed more than 30 petechiae in the right antecubital fossa. A haematological examination showed: red blood cells 4.90x106/microL with haematocrit of 43% and normal platelets. The white blood count showed 7,700 leukocytes with relative lymphopenia (22%) and the presence of numerous activated lymphocytes. The ESR was 28 mm at 1 hour, with CRP=6.62 mg/dL. Coagulation tests were normal for both tracts. Biochemistry showed a creatinine of 1.28 mg/dL with ALT=78 U/L transaminitis. Gross gout and blood smear were negative. Finally, the immunological analysis determined: negative MgIgAc against CMV, negative HBcAc, HBsAgAg and HBsAgAg, negative MgIgAc against P. falciparum and positive MgIgAc against dengue (IFA). Blood smear and blood smear did not detect the presence of blood parasites.
The patient was diagnosed with classical dengue with probable criteria for ASA-induced dengue haemorrhagic fever grade 1. After withdrawal, the patient recovered completely within 10 days.