Dengue fever (DF) presents with a myriad of symptoms. Abdominal pain is uncommon in DF. We report a case of DF presenting as pancreatitis. A 44 year old male presented to our hospital with severe epigastric pain, vomiting and fever for one week. He is a teetotaler with no past medical history. His symptoms started after a trek in rural Malaysia. There was an outbreak of DF in the community. Examination revealed epigastric tenderness. His liver function test was abnormal (alanine transaminase 239u/l, aspartate transaminase 598u/l). His amylase (162mmol/l) and lipase (147mmol/l) were elevated. Computerized tomogram of the abdomen showed features of pancreatitis but no gallstones or malignancy. Diagnostic work up for other causes of pancreatitis yielded negative results. He had mild pancreatitis with no evidence of circulatory dysfunction. Despite treatment, he developed worsening thrombocytopenia and petechiae. Serological test for dengue (Ig M) was positive. He improved with symptomatic treatment and was discharged.
DF is endemic in Singapore and is associated with significant mortality(10%). Abdominal pain is unusual but an important symptom in DF. Common causes of abdominal pain in DF include acute hepatitis (36%), acalculous cholecystitis (16%), pancreatitis (14%) and enteritis (14%). Primary presentation as pancreatitis is extremely rare. Diagnosis can be difficult as it could be secondary to plasma leakage and hypoperfusion from DF. The exact pathogenesis of pancreatic involvement in DF is not known. High index of suspicion is needed for early diagnosis and avoidance of serious complications.
This is the first case report of DF manifesting as pancreatitis in Singapore. Pancreatitis should be considered in DF presenting with abdominal pain. Early recognition and treatment can prevent mortality.