Expanded Dengue Syndrome Presenting as Acute Pancreatitis

Richmond R Gomes

doi:10.31579/2690-8794/098

Abstract

Dengue is a painful, debilitating mosquito-borne disease(female mosquitoes of the Aedes genus, principally Aedes aegypti)caused by any one of four closely related dengue viruses.It is endemic in tropical and subtropical continent. World health organization (WHO) currently estimates there may be 50 -100 million dengue infections worldwide every year with over 2.5 billion people at risk of dengue. Symptomatic dengue virus infection may manifests as undifferentiated fever, classical dengue fever (with or without unusual hemorrhages), and dengue hemorrhagic fever(with or without shock). Expanded dengue syndrome (EDS) was coined by WHO in the year 2012 to describe cases, which do not fall into either dengue shock syndrome or dengue hemorrhagic fever. The atypical manifestations noted in expanded dengue are multisystemic and multifaceted with organ involvement, such as liver, brain, heart, kidney, central/peripheral nervous system, gastrointestinal tract, lympho reticular system. Here we present a case of 35 years old female without any comorbidities who was serologically diagnosed with dengue developed severe upper abdominal pain on 2ndafebrile day and eventually diagnosed as acute pancreatitis both by raised serum lipase and ultrasonographic evidence of swollen pancreas. She was treated conservatively and improved. Thus, all clinicians should keep in mind the possibility of acute pancreatitis as a part of expanded dengue syndrome.

Highlights

Dengue is an arboviral infection common in tropical countries, including South and Southeast Asia and Western Pacific regions [1]
Expanded dengue syndrome (EDS) is a terminology introduced by the World Health Organization (WHO) in 2012 to encompass the unusual manifestations of dengue involving severe damage to the liver, heart, kidneys or brain which do not fall into either dengue shock syndrome or dengue hemorrhagic fever
Acute pancreatitis may be under diagnosed as a manifestation of dengue due to lack of awareness and it is likely that mild forms without any local and systemic complications may be missed

Summary

Introduction

Dengue is an arboviral infection common in tropical countries, including South and Southeast Asia and Western Pacific regions [1]. A 35 years old lady, school teacher, not known to have any diabetes mellitus, hypertension, coronary artery disease or bronchial asthma presented to us with the history of high grade, intermittent fever, severe headache, bodyache and retro orbital pain for 4 days, vomiting for several times and severe prostration for 1 day She denied any altered consciousness, convulsion, cough, chest pain, palpitation, shortness of breath, abdominal pain or distension, burning micturition, joint pain. Ultrasonography of whole abdomen revealed ascites, bilateral pleural effusion (figure 2), thickened gall bladder wall and abnormal hepatic parenchyma (figure 3) and swollen pancreas (figure4) She was labelled as acute pancreatitis as a spectrum of EDS. On follow up at outpatient door after one week, she was asymptomatic apart from some post viral asthenia Her amylase, lipase, SGPT, SGOT came within normal limit

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