Background <p>Dengue fever poses a major global public health challenge, with a rising burden in countries like Nepal, where it can progress to severe dengue. Severe dengue, as defined by WHO criteria, manifests with critical plasma leakage leading to shock, severe hemorrhagic complications, and organ impairment. Epistaxis, though not a classic presenting symptom, may reflect underlying coagulopathy and signal heightened disease severity. However, the demographic profile, clinical characteristics, and outcomes of dengue patients presenting with epistaxis remain undescribed in Nepal. This study describes the clinical and laboratory profile of such patients admitted to a tertiary care hospital.</p> Methods <p>We performed a retrospective observational study based on hospital records of patients admitted to Tribhuvan University Teaching Hospital, Kathmandu, Nepal, between 1st September 2022 and 30th November 2024. Patients with NS1-positive dengue fever who developed epistaxis during the course of illness were included. Data on demographics, comorbidities, prior medication use, timing of epistaxis, hospital stay, additional bleeding manifestations, hematological parameters (platelet count, WBC count, PT/INR), liver enzymes (AST/ALT), and transfusion requirements were analyzed.</p> Result <p>A total of 27 patients with dengue fever and epistaxis were evaluated. The mean age was 42 years, and the majority (70.37%) were male. Epistaxis was the initial presentation among 59.26% of patients, while 40.74% developed it during hospitalization. Epistaxis typically occurred around day 4–7 of illness. At the time of epistaxis, the mean WBC count was 5462.96/µL (range 1,600 − 14,700/µL), and the mean platelet count was around 30,000/µL. /µL. Decreasing trend of WBC counts and an increasing trend of platelet counts were seen in the majority of patients. AST and ALT were elevated (mean AST 424 U/L, ALT: 166 U/L). One-third of patients experienced additional bleeding, most commonly from oral mucosa, followed by GI bleeding. Overall, 62.96% required transfusion, and the mean platelet transfusion was about 4 pints. Among those with bleeding from other sites, 89% required transfusion, highlighting the increased severity in this subgroup.</p> Conclusion <p>Epistaxis in dengue patients most commonly occurs during the critical phase of illness and is associated with severe thrombocytopenia, hepatic dysfunction, and an increased risk of multisite bleeding. Although not all patients require transfusion, epistaxis may serve as an early clinical marker of severe dengue, underscoring the need for vigilant monitoring and timely intervention to prevent complications.</p> Clinical trail <p>Not applicable.</p>