Dengue continues to be a major mosquito-borne disease of serious public health concern. Children are usually the most affected group, but in recent decades, dengue and severe dengue have become more common among adults. Here we reviewed ten fatal dengue cases with a view to determine if there have been changes in the presentation of severe to fatal dengue. Our findings revealed high dengue mortality among adult females, associated with secondary dengue infection. Underlying co-morbidities particularly diabetes mellitus were common in our cohort. This may contribute to the rapid deterioration of clinical condition seen in severe dengue. Most patients presented with common clinical and laboratory warning signs for severe dengue. Uncommon presentations seen among our fatal cases are likely a reflection of the changing demography of dengue from children to more of an adult disease in dengue endemic countries. Our findings, hence, emphasize the importance of healthcare awareness of clinical warning signs for severe dengue, especially in adult females with underlying co-morbidities and secondary dengue infection