Dengue Versus Multisystem Inflammatory Syndrome – When the Grey Zone Gets Thinner

Despite the decline in COVID-19 cases, the potential threat of multisystem inflammatory syndrome (MIS) - a hyperinflammatory response following acute SARS-CoV-2 infection - looms large. Although initially described in children, it is being increasingly reported in adults. In dengue endemic regions, MIS is likely to cause diagnostic dilemma with dengue due to overlapping clinical and laboratory features. We describe a young male with fever, gastrointestinal symptoms, a transient rash, thrombocytopenia, and positive dengue NS1 antigen test. Early onset of thrombocytopenia, significant gastrointestinal symptoms and protracted fever were atypical, raising suspicion of MIS-A in view of a recovery from a recent SARS-CoV-2 infection. However, absence of neurologic and cardiac manifestations, stable hemodynamics, absence of mucosal involvement and negative inflammatory markers helped in managing the patient conservatively as dengue. This case highlights diagnostic challenges faced by clinicians treating suspected dengue in the face of increasing recognition of MIS and need for systematic research to establish diagnostic criteria for MIS-A.