Dengue and acute gingival bleeding.

Sir,

The recent report on dengue and acute gingival bleeding is very interesting.[1] Khan et al. reported a case presenting with acute gingival bleeding with a history of fever, weakness, backache, retro orbital pain and ecchymosis over his right arm.[1] In fact, the present case showed many bleeding presentations. Gingival is only a sign indicating hemorrhagic complication. Based on our previous experience, there are several uncommon bleeding presentations in dengue,[2] which can be seen without fever and this leads to the difficulty in diagnosis.[3] Focusing on gingival bleeding, Murillo-Llanes et al. reported that this presentation was associated with thrombocytopenia below 39,000/mm.[4] As Khan et al. noted,[1] dengue should be included in the differential diagnosis of any patient presenting with gingival bleeding, either with or without fever. Also, gingival bleeding should be looked for in patients with dengue since it can be a good early sign for predicting severe thrombocytopenia.[5]