Abstract
BackgroundWith the increasing number of dengue virus infections imported into Germany, knowledge about the different phases of the disease and possible complications is essential for the treatment of patients. The virus is endemic in the tropics and subtropics and up to 2.5 billion people are at risk of infection.Case presentationHere we present a German traveller with dengue shock syndrome after returning from Thailand. After hospitalization the patient developed acute upper abdominal pain. The ultrasound findings were consistent with an acute acalculous cholecystitis, but were interpreted as dengue associated gallbladder wall thickening (GBWT). Therefore a surgical intervention was not indicated and would have been associated with an higher risk of complications in this situation. Under supportive care spontaneous regression of GBWT could be documented by sonography four days later as well as complete resolution of clinical symptoms.ConclusionGBWT in dengue virus infection mimicking acute cholecystitis is a differential diagnosis one should take into consideration in travellers returning from endemic areas and should be managed conservatively because of an high risk of bleeding and increased mortality under surgical therapy.
Highlights
With the increasing number of dengue virus infections imported into Germany, knowledge about the different phases of the disease and possible complications is essential for the treatment of patients
About 2.5 billion people are at risk of infection and 390 million infections are estimated to occur annually in 125 countries [1]
Blood examinations 8 days after discharge and 20 days after beginning of the symptoms showed a positive serology for Dengue: Dengue-IgG was higher than 200.00 RU/ml (< 22 RU/ml) and the Index to Dengue-IgM was Discussion While dengue fever causes approximately 390 million infections and nearly 25,000 deaths worldwide annually, only 956 imported cases were reported to the Robert Koch Institute in Germany in 2016 [12, 13]
Summary
Dengue fever in Germany is still a rather rare diagnosis, but due to travel activities to endemic areas not a disease to be forgotten. Given the uncertainty that often exists in dealing with the disease in Germany and the risk of developing Dengue Shock Syndrome, a well thought-out procedure is necessary. In conclusion of this case presentation, signs of an acute abdominal pain in combination with the ultrasound finding of acalculous cholecystitis should not be treated surgically if a Dengue infection is assumed or proven. Authors’ contributions NFF and BJ initiated this case report. NFF wrote this manuscript under supervision of BJ. All authors read and approved critically the manuscript. Ethics approval and consent to participate Not applicable. Competing interests The authors declare that they have no competing interests
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