a 31-year - old indian woman , with a history of hypothyroidism ( on levothyroxine tablets 100 g / day ) presented with a history of fever of 104f of 5-day duration to the department of internal medicine ; investigations done at a laboratory of paras hospital , gurgaon , showed low platelet counts ( 45,000/cumm ) with positive dengue serology both immunoglobulin g and m ) . one day after admission in the hospital , she had sudden loss of vision in both eyes with headache and vomiting . on neurosurgery consultation , she was conscious , oriented with bilateral complete loss of vision ( no perception of light ) and no direct or consensual light reflex with a pupil size of 4 mm in diameter . rest of the neurological exam was normal ; magnetic resonance imaging ( mri ) of the brain revealed pituitary macro adenoma of 16  22 mm size with evidence of acute hemorrhage ( iso- to hyperintense on t1 and hypointense on t2 ) with enhancement of the tumor on contrast [ fig . 1 ] . serum prolactin was 11.68 ng / ml ( normal 4 - 30 ng / ml ) and serum thyroid stimulating hormone ( tsh ) was 4.649 iu / ml ( normal 0.33.0 iu / ml ) on thyroxin replacement therapy . urgent transnasal trans sphenoidal decompression of the macroadenoma was done , after replacing platelets ( > 100,000/cumm ) . vision was 20/60 and 20/40 in the right and left eye , respectively , with residual bilateral temporal field defects after 3-month follow - up . dengue hemorrhagic fever is one of the causes of low platelet count leading to petechial rash and spontaneous bleeding from mucosal surfaces . our case was a patient diagnosed with dengue hemorrhagic fever with a low platelet count without any rash or systemic bleeding . this catastrophe had arisen due to bleeding into the pituitary adenoma , probably predisposed by the low platelet count due to dengue hemorrhagic fever . in medical literature , this association has never been reported . by pointing out this rare association , authors want to emphasize that a low platelet count due to dengue hemorrhagic fever may cause pituitary adenoma apoplexy . under this condition , mri of the brain should be done and pituitary hormones levels should be checked to rule out pituitary apoplexy . other causes of visual deterioration in patients with dengue fever are optic neuropathy , maculopathy , retinal capillary occlusion , foveolitis , and retinal hemorrhage . if the diagnosis is made in time , urgent treatment in the form of decompression of optic nerves through transnasal trans sphenoid route may help to save vision as in the presented case .
dengue hemorrhagic fever leading to hemorrhage in pituitary adenoma is not reported till date : we herein report the first case of bilateral visual loss secondary to pituitary adenoma hemorrhage associated with dengue hemorrhagic fever . 
 urgent transnasal trans sphenoidal decompression of the macroadenoma prevented permanent visual loss in this patient . 
 pituitary apoplexy should be considered as differential diagnosis of visual deterioration apart from retinal hemorrhage , maculopathy , and optic neuropathy in cases of dengue hemorrhagic fever . 
 early decompression of optic nerves helped in the restoration of vision .