The absence of dengue virus in the skin lesions of dengue fever.

Patients with confirmed dengue infection were studied in an attempt to elucidate the cause of the eruption of dengue fever. Punch biopsies of lesional skin were obtained and processed for the presence of viral antigen and immune globulins by the direct fluorescent antibody test. Another biopsy specimen and the acute sera were processed for virus isolation. Although virus was isolated from the serum of two patients, isolation attempts from the biopsy specimens of all four patients were negative. Fluorescent antibody studies revealed no evidence of either viral antigen or immune globulins in lesional skin. Although limited, the data suggest that the maculopapular rash of dengue fever may be caused by some mechanism other than direct viral infection of the skin or involvement of immune globulins.