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Expanded dengue syndrome: three concomitant uncommon presentations in the same patient
Ahmad Mursel Anam1, Raihan Rabbani2, Farzana Shumy3
11 Chief Resident, ICU, Square Hospitals Ltd., Dhaka, Bangladesh.
Tropical Doctor
|April 21, 2017
Summary
This case study details a rare instance of expanded dengue syndrome. A patient experienced acute cholecystitis, pancreatitis, and hemophagocytic syndrome simultaneously, a combination previously unreported in dengue hemorrhagic fever.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Hematology
Background:
- Dengue hemorrhagic fever (DHF) is a severe form of dengue infection.
- Expanded dengue syndrome encompasses a spectrum of severe manifestations beyond classical symptoms.
- Uncommon complications of DHF include acute pancreatitis and acalculous cholecystitis.
Observation:
- A single patient with DHF presented with concurrent acute acalculous cholecystitis and acute pancreatitis.
- Following the resolution of these gastrointestinal complications, the patient developed pancytopenia.
- The pancytopenia was strongly suspected to be a manifestation of hemophagocytic syndrome.
Findings:
- This case represents the first reported instance of acute acalculous cholecystitis, acute pancreatitis, and hemophagocytic syndrome occurring together in a single patient with DHF.
- The simultaneous occurrence of these three distinct and rare complications highlights the complex and varied clinical spectrum of severe dengue.
Implications:
- This case expands the understanding of expanded dengue syndrome and its potential manifestations.
- Clinicians should consider a broader range of complications, including gastrointestinal and hematological issues, in patients with severe dengue.
- Further research is warranted to elucidate the mechanisms underlying these concomitant presentations in DHF.