Dengue fever presenting as acute appendicitis

Abstract

INTRODUCTION: Dengue-fever (DF) is known to present with surgical emergencies, including acute pancreatitis and acalculous cholecystitis. CASE RECORDS: During 2006, 12 patients [5 males, mean age 28(SD 4.6) years] presented with features of acute appendicitis and were later diagnosed as having DF. Seven were admitted to surgical casualty and referred for medical opinion due to thrombocytopenia (one following appendicectomy). Five were first seen by physicians and referred for surgical assessment. The mean time from onset of fever to abdominal pain was 2.2 days (SD 0.9). Clinical features at presentation included: right iliac fossa tenderness in 12 (100%), rebound tenderness in 9 (75%), vomiting in 9 (75%), erythematous rash in 8 (67%), arthralgia/myalgia in 8 (67%), headache in 6 (50%), diarrhoea in 3 (25%) and palatal petechiae in 3 (25%). All patients had CRP <12 mg/1 and DF was confirmed on IgM/IgG ELISA (Panbio, Australia). Leucocytopenia and thrombocytopenia occurred in 8 (67%) and 10 (83%) on admission and in 11 (95%) and 12 (100%) during hospital stay. Seven (58%) had free fluid around the appendix on ultrasound scan. Histology in one showed non-specific lymphoid-follicular hyperplasia. Only one patient (who underwent appendicectomy) received IV antibiotics. The mean duration for disappearance of abdominal pain and severe tenderness from the time of first examination was 1.8 days (SD 1.3). Discharge diagnoses were: classical DF in 3(25%), DHF (platelets <100xl09/iitre) in 7(58%) and DSS in 2(17%). Conclusions: DF may present as acute appendicitis. An early blood count and C-reactive protein can help to differentiate dengue fever from acute bacterial appendicitis.