OBJECTIVE: Dengue is a mosquito-borne Arbor-viral infection with four main subtypes. Sri Lanka has been affected by several dengue epidemics during the last three decades. The clinicopathological entities of dengue may differ with each individual subtype or combination. This study describes clinicopathological findings of a series of 7 fatal dengue cases during an outbreak in early 2019, mainly due to Dengue virus three serotype (DENV3).

CASE PRESENTATION: All seven cases were serologically diagnosed and managed as Dengue infection at Teaching Hospital, Karapitiya during the year 2019. Out of these, four were female, and three were male, with a majority between 30 to 35 years. Six patients had been managed with blood transfusion, and two of them had undergone dialysis. All deaths in this study have occurred between 6 to 8 days of the first symptom, during the leaking phase. Autopsies revealed evidence of plasma leakage and bleeding with DIC in all cases. Hepato-renal involvement was confirmed microscopically with evidence of acute liver cell necrosis and acute tubular necrosis. Diffuse alveolar damage suggestive of ARDS was seen in five, while viral myocarditis was diagnosed in two cases. Cerebral involvement was not prominent except severe cerebral oedema seen in one case suggestive of viral encephalopathy that presented with fits.

CONCLUSIONS: In this cohort, the majority has presented with typical symptoms and deteriorated rapidly since day 4 or 5 onwards until death intervened with multi-organ failure and shock. Knowledge regarding sequential epidemics caused by different serotypes of dengue virus together with their clinicopathological entities is essential for early prediction and proper interventions.