Abstract
BackgroundDengue fever is a common mosquito borne viral fever in South Asia, which causes significant morbidity and mortality. Dengue fever is well known to involve the liver, especially in dengue hemorrhagic fever. The hepatic involvement is usually that of a mild hepatitis with transaminase derangement without jaundice. In cases of dengue hemorrhagic fever where shock has ensued, a severe hepatitis with gross derangements of transaminases and bilirubin may occur. These are two rare cases of adult patients with dengue hemorrhagic fever presenting with a cholestatic type of jaundice.Case presentationThis case report describes two female patients aged 30 and 46 years who presented with fever, icterus and biochemical analysis revealed cholestatic jaundice. Evolution of the clinical picture and dropping platelets prompted serological investigations in the form of dengue non-structural protein 1 antigen and dengue immunoglobulin M which confirmed acute dengue infection.ConclusionThese cases highlight the importance of considering dengue fever as a differential diagnosis even in the presence of a cholestatic jaundice, especially in countries where dengue fever is endemic, and in travelers returning from dengue endemic countries. The early diagnosis of dengue fever and timely institution of supportive fluid management is essential to prevent morbidity and mortality.
Highlights
Dengue fever is a common mosquito borne viral fever in South Asia, which causes significant morbidity and mortality
These cases highlight the importance of considering dengue fever as a differential diagnosis even in the presence of a cholestatic jaundice, especially in countries where dengue fever is endemic, and in travelers returning from dengue endemic countries
We describe two patients who had in addition to fever had cholestatic jaundice as an initial presenting symptom which was due to dengue infection
Summary
These cases highlight that in addition to deranged liver enzymes, cholestatic pattern of jaundice may be an under recognized clinical manifestation of dengue fever. A high suspicion of dengue should be present when other supportive clinical and laboratory criteria are present in addition to that of jaundice. Consent Written informed consent was obtained from both patients for publication of this Case Report. Competing interests The authors declare that they have no competing interests. Author’s contributions JY carried out the literature search and drafted the manuscript; AR and RN did critical revision for important intellectual content in the manuscript and gave the final approval of the version to be published; SJ helped substantially in literature search and drafting the manuscript. All authors provided clinical care for the patient and have read and approved the final manuscript
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