Elevated AST and ALT levels have been associated with bleeding [2, 4, 6] and dengue hemorrhagic fever (DHF) [3, 8] . Liver failure has been recognized as a complication and unusual manifestation of dengue [9, 10] but occurred infrequently in 3 of 270 patients in Taiwan [6] and 5 of 644 patients in Vietnam [4] . In Malaysia, 8 of 20 pediatric DHF patients developed liver failure, 1 died, and the rest recovered completely [11] . In Singapore, AST or ALT levels were not independent predictors of DHF in 1973 adult dengue patients [12] .