Spontaneous splenic rupture: A rare presentation of dengue fever
A 26-year-old female presented to the emergency department with an acute abdominal pain and prostration in a background of intermittent fever and watery diarrhea for 4-5 days. Her past medical history was unremarkable. On examination, she had severe pallor, tachycardia (pulse 120/min), tachypnea and a blood pressure (BP) of 90/60 mm Hg. There was a marked tenderness over all quadrants of the abdomen with ascites and hepatosplenomegaly. Other systemic examinations were non-contributory. Initial investigations revealed, hemoglobin (Hb)-3.4 g/dl, total leukocyte count-3.3 × 109/l (N-90%, L-8%, E-2%), platelet count -40 × 109/l packed cell volume 12.2%, mean corpuscular volume 87 fl; microscopic examination of urine was normal.\nLiver function test, serum amylase, lipase and electrolytes were within normal limits, but values of serum urea was 88 mg/dl and serum creatinine was 2 mg/dl. An urgent straight X-ray abdomen showed no evidence of pneumoperitoneum, whereas the chest X-ray revealed bilateral pleural effusions []. Diagnostic ascitic fluid tap from multiple quadrants showed hemoperitoneum. She was resuscitated with intravenous normal saline and blood transfusions (4 units of packed cells and 6 units of platelets) dopamine was used transiently in the first 24 h when fluids failed to raise BP adequately. After she became hemodynamically stable, ultrasonography was done and the report corroborated with clinical findings. The tourniquet test was normal. There was no growth of any organism in ascitic fluid and blood culture. Card test for pregnancy was negative. Subsequently computed tomography scan of the abdomen showed perisplenic hypoattenuating collection with the splenic border displaced by mass effect. There was also ascites and hepatosplenomegaly []. Patient denied any abdominal trauma; hence a diagnosis of hemoperitoneum due to spontaneous splenic rupture was entertained. Partial thromboplastin and activated partial thromboplastin time were within normal range. She was seronegative for malaria dual antigen, Widal test and human immunodeficiency virus. Blood test for Epstein-Barr virus was negative but dengue serology was positive for non-structural protein 1 (antigen capture ELISA) and immunoglobulin M (IVD micro-well ELISA DF kit) sent on the 2 day of admission (7th day after the onset of fever). Meanwhile her hemogram improved on the 4th day onward-Hb 11.4 g/dl, platelet 130 × 109/l and hematocrit was 47%. She was discharged after 7 days of in-patient stay.