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An unusual cause of acute abdominal pain in dengue fever

Published:January 23, 2014DOI:https://doi.org/10.1016/j.ajem.2014.01.011
      Dengue fever is an acute febrile viral disease caused by the bite of Aedes aegypti mosquito. It is a major health problem especially in tropical and subtropical areas including South East Asia and Pakistan. In the past few years, dengue fever has been endemic in Northern Punjab. Physicians managing dengue fever come across varied and uncommon complications of dengue fever. We report a case of dengue fever that developed severe right upper quadrant abdominal pain and induration after extreme retching and vomiting for 2 days. A rectus sheath hematoma was confirmed on noncontrast computed tomography (CT). Rectus sheath hematoma as a complication of dengue fever has rarely been reported before and never from this part of the world. Rectus sheath hematoma is an uncommon and often clinically misdiagnosed cause of abdominal pain. It is the result of bleeding into the rectus sheath from damage to the superior or inferior epigastric artery or their branches or from a direct tear of the rectus muscle. It can mimic almost any abdominal condition (See Fig.) (See Table).
      TableLaboratory investigations
      Day 1 Day 3 Day 5 Day 7
      Hemoglobin level g/dL 13.2 12 8 7
      White blood cells (mm3) 7500 3500 2100 2200
      Platelets (mm3) 65,000 17,000 9000 12,000
      Hematocrit (%) 39 37 32 35
      Prothrombin time (s) 17 21 27 31
      NS-1 antigen Positive
      PCR for dengue RNA Detected
      Blood glucose (mg/dL) 164 178 210 128
      Serum albumin (g/dL). 2.8 2.3 2.1 3.4
      Abbreviations: NS-1, non structural protein 1; PCR, polymerase chain reaction.
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