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Introduction Dengue fever (DF) is the most common arbovirus-related infection worldwide. Most of the dengue infections are asymptomatic. The clinical presentation of DF varies from mild febrile illness to dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Both DHF and DSS are severe forms of illness and carry higher rates of mortality. Various clinical parameters are associated with severe DF. The objective of this study was to determine any relation between elevated alanine aminotransferase (ALT) levels at presentation and development of sever