Background The clinical manifestations of imported dengue in adult Western travelers were analyzed. Methods The charts of all adult patients with dengue, who were seen in an academic hospital in The Netherlands from 1985 to 1994, were studied. Results Dengue was confirmed in 34 patients by a fourfold rise in complement fixation antibody titer or presence of IgM. Twelve probable cases with a single high titer in the complement fixation test were found. Annual numbers have increased since 1989. Most cases were imported from Asia. Malaise (98%), fever (96%), headache (64%), chills (58%), muscle pain (53%) and arthralgia (44%) were the main symptoms. A noncharacteristic skin eruption was seen in 84%. Leukocytopenia and thrombocytopenia were found in 87% and 75%, respectively during the first week, and elevated serum aminotransferase activities were noted in 75%. Only two patients developed dengue hemorrhagic fever. Conclusions Dengue in Western taravelers is usually a relatively mild disease. Leukocytopenia, thrombocytopenia, and elevation of serum aminotransferase activities are common laboratory features.