Differential Diagnosis for Sudden Worsening of Anemia in a Patient Recovering from Mild Dengue

Single Most Likely Diagnosis

• Hemorrhagic complication of dengue: This is a likely complication given the patient's recent history of dengue fever. Dengue can cause a sudden drop in platelet count, leading to bleeding and worsening anemia. The symptoms of shortness of breath and transient dizziness could be indicative of significant blood loss or severe anemia.

Other Likely Diagnoses

• Iron deficiency anemia exacerbation: The patient's anemia could be worsening due to iron deficiency, especially if they have been experiencing chronic blood loss or have a poor diet. This, combined with the physical exertion of climbing stairs, could explain the shortness of breath.
• Cardiac complications: Myocarditis or pericarditis can occur as a complication of dengue fever, leading to heart failure symptoms such as shortness of breath and dizziness. The "whooshing" sounds could be indicative of a pericardial friction rub.
• Dehydration: Patients recovering from dengue are at risk of dehydration, which can worsen anemia symptoms and cause dizziness and shortness of breath.

Do Not Miss Diagnoses

• Pulmonary embolism: Although less likely, a pulmonary embolism could cause sudden shortness of breath and dizziness. It's a potentially life-threatening condition that requires immediate attention.
• Severe bleeding: Internal bleeding, such as gastrointestinal bleeding, could cause a sudden worsening of anemia and should be considered, especially if the patient is experiencing abdominal pain or black tarry stools.
• Cardiac tamponade: A complication of pericarditis, cardiac tamponade is a life-threatening condition that requires immediate medical attention. The "whooshing" sounds and symptoms of shortness of breath and dizziness could be indicative of this condition.

Rare Diagnoses

• Thrombotic thrombocytopenic purpura (TTP): A rare blood disorder that could cause worsening anemia, TTP is characterized by thrombocytopenia, microangiopathic hemolytic anemia, renal failure, and neurological symptoms.
• Hemolytic uremic syndrome (HUS): Another rare condition, HUS is characterized by hemolytic anemia, acute kidney injury, and thrombocytopenia. It could be considered in the differential diagnosis, especially if the patient has a history of certain infections or medications.