The article describes two women in their 80s with disseminated dengue syndrome complicated by acute pancreatitis and pericardial effusion. The first patient initially presented with fever and urinary symptoms, then severe dengue fever with shock, low platelets, acute kidney injury, and altered consciousness; computed tomography confirmed pancreatitis and pericardial effusion, she recovered after supportive care. The second patient had out-of-hospital cardiac arrest and multiorgan failure, imaging showed pancreatitis and pericardial effusion associated with dengue shock; despite resuscitation, she died the next day. These complications are rare, easily overlooked in elderly patients with atypical manifestations, and may mimic other diseases or coexist with other conditions. Early imaging, ultrasound, and hemodynamic monitoring are essential for rapid diagnosis and improved outcomes in this vulnerable group.