Abstract
Dengue infection has become a serious public health concern. Dengue management protocols and the management of common complications arebeing updated often based on understanding the Pathophysiology of dengue infection. This understanding has definitely improved dengue management resulting in reduction in dengue deaths. At times, uncommon complications may be overlooked in busy and crowded clinical settings. Spontaneous localized retro-peritoneal bleeding including bleeding into psoas muscle or Wunderlich Syndrome has been reported in few instances associated with dengue fever in this country and abroad. Thislife-threatening possibility must be born in mind when a clinician notices sudden deterioration of a dengue patient withoutsignificant thrombocytopenia, generalized bleeding manifestation or other evidence of extra vascular fluid loss. The management of this entity requires urgent restoration of the circulatory volume including urgent blood transfusion though, in general, clinicians are moreconcerned about fluid overload in the management of dengue patients. As awareness of this entity seems poor, further research and reporting of similar cases in medical literature will shed more light on this obscure entity and increase the awareness among clinicians with favorable results.
Highlights
Spontaneous retroperitoneal bleeding or Wunderlich Syndrome is a rare but well recognized condition where non-traumatic bleeding occurring into the retroperitoneal tissues with signs and symptoms of varying severity
Sub-endocardial hemorrhage and massive haematoma in relation to the left psoas muscle taken with the history of sudden collapse of the patient clearly indicate that the immediate cause of death is haemorrhagic shock
The natural course of dengue infection has been well described. It ranges from asymptomatic infection, viral syndrome, dengue fever with or without bleeding to dengue haemorrhagic fever with or without shock
Summary
Spontaneous retroperitoneal bleeding or Wunderlich Syndrome is a rare but well recognized condition where non-traumatic bleeding occurring into the retroperitoneal tissues with signs and symptoms of varying severity. Blood counts after resuscitative effort showed a haemoglobin level of 4.2g/dl and pack cell volume of 22.3. Histology showed bleeding into the muscle without inflammation in the blood vessels or surrounding tissues. Sub-endocardial hemorrhage and massive haematoma in relation to the left psoas muscle taken with the history of sudden collapse of the patient clearly indicate that the immediate cause of death is haemorrhagic shock. Coronary atherosclerosis and microscopic evidence of myocardial fibrosis indicate preexisting myocardial ischemia as well This condition could have contributed to her death
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