Clinical Profile of dengue patients presenting with epistaxis at a tertiary hospital in Nepal

Background Dengue fever can present with hemorrhagic manifestations such as epistaxis. Despite its clinical significance, the specific profile and outcome of dengue patients presenting with epistaxis remains unexplored in Nepal. We conducted record-based retrospective study to analyze demographic and clinical profile of dengue cases with epistaxis admitted to Tribhuvan University, Teaching Hospital, Kathmandu, Nepal, between 1st September 2022 to 30th November 2024. Methods A record-based retrospective study was conducted among patients with dengue fever (NS1 positive with symptoms) and concurrent epistaxis, admitted to our tertiary care center. The collected data encompassed patient demographics, underlying comorbidities, prior medication history, duration of hospital stay, additional bleeding manifestations, platelet count, WBC count, PT/INR, and AST/ALT. The requirement for blood or platelet transfusion was also assessed. Result A total of 27 patients with dengue fever and epistaxis were evaluated. The mean age was 42 years and majority (70.37%) were male. Epistaxis was the initial presentation among 59.26% patients while 40.74% developed it during hospitalization. Epistaxis typically occurred around day 4–7 of illness. At the time of epistaxis, the mean WBC count was 5462.96/µL (range 1,600 − 14,700/µL) and mean platelets count was around 30,000 /µL. Decreasing trend of WBC counts and increasing trend of platelet counts was seen in majority of patients. AST and ALT were elevated (mean AST 424 U/L, ALT: 166 U/L). One third patients experienced additional bleeding, most commonly from oral mucosal followed by GI bleeding. Overall, 62.96% required transfusion and the mean platelet transfusion was about 4 pints. Among those with bleeding from other sites, 89% required transfusion, highlighting the increased severity in this subgroup. Conclusion Epistaxis in dengue patients most commonly occurred between days 3–7 of illness, coinciding with thrombocytopenia, rising WBCs, and elevated liver enzymes. Vigilant clinical monitoring is crucial, as not all case required transfusion, but may signal risk of multisite bleeding.