The study on dengue fever is very interesting.1 Badreddine et al1 noted that “abdominal pain and vomiting, thrombocytopenia, and elevated alanine aminotransferase (ALT) are typical of severe infection, which is more likely to be associated with significant morbidity and mortality.” We would like to share ideas and experience of this topic. Indeed, dengue fever is the present global public health problem. Expanded endemic area of dengue and imported cases result in new emergence of dengue worldwide. The dengue hemorrhagic fever (DHF) is not uncommon in endemic area and the case might have atypical clinical presentation. The diagnosis of dengue require recognition of the practitioner and the prompt fluid replacement therapy is the key point for management of dengue.2 Focusing on atypical clinical presentation, gastrointestinal symptom or abnormal liver function test is not uncommon and can be easily missed.3 Sometimes, a more uncommon presentation such as hypermenorrhea or hematuria can be the solitary presentation of the patient.4 Afebrile dengue is also possible and the diagnosis is very difficult.5 Due to the expansion endemic area of dengue, dengue should be included in differential diagnosis on any patient with acute febrile illness.Thanks for your valuable point. Regarding severe dengue fever, we found that these parameter where consistent with severe dengue fever, it is essential for clinician to be aware; however, as you mentioned awareness is very essential specially in endemic areas due to unusual presentation. The findings of this study emphasized that Saudi nationals are at significant risk of dengue infection, which is important for health care profession also to recognize and may help the development of effective eradication strategies.In our series, 3 adult patients had confirmed prior diagnosis of dengue and did not develop DHF in subsequent infection, the sample size is too small to make valid conclusion, but is worth mentioning.Department of Medicine Dr. Soliman Fakeeh Hospital, Jeddah, Kingdom of Saudi Arabia