Spontaneous splenic rupture in dengue hemorrhagic fever

Abstract

A 29-year-old woman was admitted with a 7-day history of fever, myalgia, and headache. She had had recurrent melena since the third day of illness. She was febrile and anicteric. No rash or lymphadenopathy was evident, and a tourniquet test was negative. Mild hepatomegaly and shifting abdominal dullness were present. The neck was supple with no neurologic deficit. Platelet count was 90,000/µL, and hematocrit was 33%. A peripheral blood smear did not show malarial parasites, and blood cultures were sterile. Dengue virus-specific IgM antibodies were found to be positive. On Hospital Day 3, the patient had a sudden onset of abdominal pain and distension; hematocrit dropped to 15%. Paracentesis yielded frankly hemorrhagic fluid with a hematocrit of 11%. Contrast-enhanced computed tomography showed ascites (Figure 1A, asterisks) and an organized, non-enhancing collection over the posterosuperior aspect of spleen, suggestive of splenic rupture with adherent thrombus (Figure 1A, arrow); bilateral pleural effusions (Figure 1B, arrows) were also evident. She was managed conservatively with packed red cell transfusions and crystalloids. Over the next few days, hemoperitoneum and pleural effusions resolved uneventfully. Spontaneous splenic rupture is a well-known complication of acute infections such as malaria and infectious mononucleosis; nonetheless, it is rarely reported in dengue hemorrhagic fever.