Dengue fever presents a broad clinical spectrum, ranging from a benign self-limiting infection to the most severe forms such as dengue hemorrhagic fever and dengue shock syndrome. Dengue fever is endemic in Mexico; however, reports of clinical and particularly pathological studies in fatal dengue cases are limited. In this study, we report the main clinical and pathological findings of 10 fatal cases of dengue hemorrhagic fever from Morelos and Veracruz states. All cases had several bleeding manifestations during their evolution; the most frequent were ecchymosis, hematomas, petechiae and gastrointestinal and pulmonary hemorrhage. Laboratory results indicate the presence of antibodies (IgG) against dengue virus in most cases and NS1 antigen in three cases; dengue virus serotypes 1, 2 or 3 in serum were detected by virus isolation and/or by reverse transcriptase-polymerase chain reaction (RT-PCR). The most relevant macroscopic findings in necropsy cases were hemorrhages in the skin, mucosa, gastrointestinal tract, liver, heart, respiratory tract and central nervous system, as well as hepatomegaly and splenomegaly. Most common microscopic findings were intra-alveolar edema and hemorrhage, myocarditis, and interstitial edema and congestion of central nervous system.Moderate general visceral congestion was observed in all cases.