Juan Fidel Osuna-Ramos1, Carlos Silva-Gracia2, Gerardo Joel Maya-Vacio2, Alejandra Romero-Utrilla3, Efrén Rafael Ríos-Burgueño4, Jesús Salvador Velarde-Félix5. 1. Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, México. Electronic address: osram90@gmail.com. 2. Servicio de Cirugía General, Hospital General de Culiacán Bernardo J. Gástelum, Culiacán, Sinaloa, México. 3. Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, México. 4. Departamento de Anatomía Patológica, Hospital General de Culiacán Bernardo J. Gástelum, Culiacán, Sinaloa, México. 5. Unidad Académica, Escuela de Biología, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, México.
Abstract
BACKGROUND: Dengue is the most important human viral disease transmitted by mosquitoes. It can be asymptomatic or it can present in any of its 3clinical forms: Dengue fever, dengue haemorrhagic fever and dengue shock syndrome. However, some atypical manifestations have been reported in surgical emergencies caused by acute appendicitis in patients with dengue fever. CLINICAL CASE: We report the case of an 18-year-old Mexican male who presented to the emergency department of the General Hospital of Culiacan, Sinaloa, with symptoms of dengue fever, accompanied by crampy abdominal pain with positive Rovsing and Dunphy signs. Dengue infection was confirmed by a positive NS1 antigen test performed by enzyme-linked immunosorbent assay. An abdominal ultrasound revealed an appendicular process; as the abdominal pain in the right side kept increasing, an open appendectomy was performed. Abundant inflammatory liquid was observed during the surgery, and the pathology laboratory reported an oedematous appendix with fibrinopurulent plaques, which agreed with acute ulcerative appendicitis. The patient was discharged fully recovered without complications during the follow-up period. CONCLUSIONS: Acute abdominal pain can be caused in some cases by dengue infection. This can be confusing, which can lead to unnecessary surgical interventions, creating additional morbidities and costs for the patient. This unusual and coincident acute appendicitis with dengue highlights the importance of performing careful clinical studies for appropriate decision making, especially in dengue endemic regions during an outbreak of this disease.
BACKGROUND: Dengue is the most important humanviral disease transmitted by mosquitoes. It can be asymptomatic or it can present in any of its 3clinical forms: Dengue fever, dengue haemorrhagic fever and dengue shock syndrome. However, some atypical manifestations have been reported in surgical emergencies caused by acute appendicitis in patients with dengue fever. CLINICAL CASE: We report the case of an 18-year-old Mexican male who presented to the emergency department of the General Hospital of Culiacan, Sinaloa, with symptoms of dengue fever, accompanied by crampy abdominal pain with positive Rovsing and Dunphy signs. Dengue infection was confirmed by a positive NS1 antigen test performed by enzyme-linked immunosorbent assay. An abdominal ultrasound revealed an appendicular process; as the abdominal pain in the right side kept increasing, an open appendectomy was performed. Abundant inflammatory liquid was observed during the surgery, and the pathology laboratory reported an oedematous appendix with fibrinopurulent plaques, which agreed with acute ulcerative appendicitis. The patient was discharged fully recovered without complications during the follow-up period. CONCLUSIONS: Acute abdominal pain can be caused in some cases by dengue infection. This can be confusing, which can lead to unnecessary surgical interventions, creating additional morbidities and costs for the patient. This unusual and coincident acute appendicitis with dengue highlights the importance of performing careful clinical studies for appropriate decision making, especially in dengue endemic regions during an outbreak of this disease.