When Fever Turns Hemorrhagic in the Maldives: A Case Report of Dengue in a G6PD-Deficient Young Adult With Hemolysis and Rhabdomyolysis.

Dengue is endemic in the Maldives and remains a major public health concern in this small island nation of approximately half a million people. Genetic red blood cell disorders, particularly thalassemia, are common; however, the prevalence of other inherited disorders, such as glucose-6-phosphate dehydrogenase (G6PD) deficiency, remains poorly characterized. Despite this, sporadic cases of hemolytic anemia in G6PD deficient individuals have been reported. The presence of G6PD deficiency may alter the clinical course of acute dengue infection, as illustrated in the case presented, and require careful management to prevent complications. A 22-year-old male presented with fever, headache, nausea, vomiting, and jaundice, which rapidly progressed to include epistaxis and dark-colored urine. Laboratory findings revealed leukopenia, thrombocytopenia, elevated unconjugated bilirubin, markedly reduced G6PD activity, and elevated creatine kinase levels. While the dengue NS1 antigen test was positive during acute illness, follow-up serology at 8 months remained negative. This case depicts the potential for concurrent hemolysis and rhabdomyolysis in G6PD-deficient patients with dengue in endemic settings. Clinicians should maintain a high index of suspicion for these complications in patients presenting with fever and jaundice, as early recognition through vigilant clinical observation may influence management and clinical outcomes.