Delayed dengue-associated hemorrhagic pericarditis with cardiac tamponade in elderly patient

An 88-year-old woman developed hemorrhagic fibrinous pericarditis with cardiac tamponade approximately three weeks after a conservatively managed dengue infection, according to a case report in BMC Infectious Diseases . The patient was treated at a tertiary care center in the United Arab Emirates. She had chronic immune thrombocytopenia and persistent antiphospholipid antibody positivity before becoming ill with dengue.

About three weeks later, she presented with progressive dyspnea and chest discomfort and was approaching hemodynamic collapse. Echocardiography revealed a circumferential pericardial effusion with fibrinous strands and findings interpreted as cardiac tamponade. These observations documented the pericardial process and its acute cardiovascular consequences in this individual patient.

Clinicians performed emergent pericardiocentesis, which yielded frank hemorrhagic fluid. The procedure was followed by a dramatic improvement in the woman’s symptoms and functional status. She continued to improve during hospitalization and was ultimately discharged while ambulatory, without recurrent hemodynamic compromise.

Serial analyses of pericardial fluid documented an evolution from an acute hemorrhagic inflammatory phase toward an organizing fibrinous exudative stage. Cytologic examination showed inflammatory hemorrhagic smears containing hemosiderophages, with no malignant cells identified. Dengue immunoglobulin was detected in the pericardial fluid, strengthening the temporal and immunologic association with the recent infection.

The clinical team also investigated tuberculous, malignant, bacterial and connective tissue disease causes of the effusion. These extensive evaluations did not identify an alternative etiology. The negative investigations supported the report’s classification of the condition as dengue-associated, although a single case cannot determine the incidence, mechanisms or clinical importance of the complication across patient populations.

The authors emphasized that dengue-associated cardiac tamponade is rare, particularly among elderly patients with thrombocytopenic or autoimmune vulnerability. In this case, the patient’s advanced age, chronic immune thrombocytopenia and persistent antiphospholipid antibody positivity accompanied a severe, delayed pericardial complication. Because the evidence comes from one patient, the report cannot establish how often this presentation occurs, whether dengue directly initiated the pericardial inflammation or whether pericardiocentesis produced favorable outcomes in comparable patients.

Nevertheless, the documented recovery following emergency drainage shows that the case is clinically relevant and alerts clinicians to a potential post-infectious presentation requiring differentiation from tuberculosis, malignancy and other causes of hemorrhagic pericardial effusion.

Subject of Research: A case report of delayed dengue-associated hemorrhagic fibrinous pericarditis with cardiac tamponade in an elderly patient.

Article Title: Delayed dengue-associated hemorrhagic fibrinous pericarditis with cardiac tamponade: clinicopathologic characterization of a rare post-infectious cardiovascular complication

Article References: Para, N. K. O., Thomas, G., Koshy, G., Misra, V., Awadh, K. M. A., & Sundaram, S. (2026). Delayed dengue-associated hemorrhagic fibrinous pericarditis with cardiac tamponade: clinicopathologic characterization of a rare post-infectious cardiovascular complication. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14379-z

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14379-z

Keywords: dengue, pericarditis, cardiac tamponade, hemorrhagic effusion, fibrinous exudate, pericardiocentesis, immune thrombocytopenia, antiphospholipid antibodies, case report, viral infection, Delayed, dengue-associated