A rare case of unusual presentation of acute necrotising pancreatitis as a presenting feature of dengue haemorrhagic fever in a child

Abstract

Background: Dengue fever is an acute viral infection seen commonly in developing countries. Its presentation varies in children starting from mild illness to severe complications. Acute necrotising pancreatitis is a serious form of pancreatitis which is a very rare entity in children. Here we are presenting a rare case of unusual presentation of acute necrotising pancreatitis as a presenting feature of dengue fever. Case details: A 15 years male child presented with history of pain, distension of abdomen and vomiting. Patient had history of fever off and on since one month. Per abdomen examination showed ascites, hepatomegaly. Dengue NS1 antigen and dengue serology IgM was positive. Serum amylase level and lipase level were 1540 U/Land 960 U/L respectively. Contrast enhanced CT scan and MRCP showed bulky pancreas with decreased enhancement with ascites. Patient was managed conservatively with intravenous fluids, antibiotics and octreotide and patient was discharged successfully. Acute necrotising pancreatitis as a presenting feature of dengue fever has not been reported in children to the best of my knowledge. Conclusion: Clinical presentation of dengue fever varies but when patient presents with pain in abdomen, vomiting and fever then acute pancreatitis should be ruled out. In such patient clinical suspicion is important and timely intervention may lead to complete recovery and good outcome.