Dengue fever, a common arthropod-borne viral infection, presents a wide spectrum of clinical manifestations ranging from asymptomatic to severe dengue hemorrhagic fever (DHF). While muscle hematomas are an unusual complication of dengue fever, they can signal life-threatening progression of the disease. A case of spontaneous psoas hematoma associated with dengue hemorrhagic fever was reported, underscoring the need for a high index of clinical suspicion in endemic areas to prevent mortality.
In an alarming display of the complications associated with dengue hemorrhagic fever, a 28-year-old male patient was admitted to the Dengue High Dependency Unit at Colombo South Teaching Hospital in Sri Lanka with severe dengue symptoms. Despite initial improvement with intravenous fluid therapy and supportive measures, the patient developed acute pain in the left groin and inguinal region during the critical phase of the disease, with physical examination remaining unremarkable.
An ultrasound scan revealed a significant hematoma within the left psoas muscle. This unexpected diagnosis led to immediate action, as the patient’s hemodynamic condition began to deteriorate, necessitating blood transfusion. Fortunately, with prompt and effective treatment, he recovered without further incident and was discharged from the hospital in stable condition.
DOI: 10.1186/s12879-019-4023-2
This case, detailed in BMC Infectious Diseases (Matthias et al., 2019), brings to light the critical nature of vigilant monitoring for complications in dengue fever patients. In Sri Lanka, dengue is a rapidly escalating public health concern, with the highest number of cases reported in 2017. According to the Weekly Epidemiological Report by the Epidemiology unit of Sri Lanka in January 2018, the country is in the midst of dengue outbreaks on an unprecedented scale.
The Steep Rise of Dengue in Sri Lanka
Dengue fever, caused by the dengue virus (DENV), transmitted by Aedes aegypti and Aedes albopictus mosquitoes, remains a significant burden in tropical and subtropical regions. A comprehensive analysis of a dengue virus serotype 2 outbreak by Wijewickrama et al. (2018) highlighted the epidemic nature of dengue in Sri Lanka. This underscores the need for improved surveillance and diagnoses, as well as an understanding of the atypical manifestations of this febrile illness.
The Pathogenesis and Complications of DHF
Dengue hemorrhagic fever results from a complex interplay of viral and host factors, leading to capillary permeability, bleeding manifestations, and, if not managed correctly, eventual shock. Coagulation abnormalities, as detailed in the study by Wills et al. (2002), complicate the clinical picture, necessitating a keen eye for non-typical presentations such as muscle hematomas.
Psoas Hematoma as a Serious Complication
The development of spontaneous psoas hematoma in the context of dengue hemorrhagic fever is exceptionally rare. However, it carries significant morbidity and can be potentially life-threatening. Literature on the subject is sparse, but cases such as that reported by Sellahewa (2015), Ameer et al. (2009), and those mentioned in the case report by Matthias et al. (2019) illustrate the variegated nature of dengue complications.
The Management of Hematological Disturbances
Effective management of hematological disturbances in dengue requires a comprehensive approach including fluid replacement, monitoring of hematocrit levels, and platelet counts. Blood transfusion, as was necessary in this reported case, is considered when there are signs of significant bleeding or hemodynamic instability. The knowledge of the autoimmune pathogenesis in dengue virus infection, as postulated by Lin et al. (2006), adds another layer to the intricate management of these complications.
Diagnosis and Clinical Vigilance
Diagnosis of dengue and its complications primarily relies on clinical findings and serological tests to detect viral antibodies. Imaging, such as ultrasonography used in the reported case, plays a crucial role in identifying atypical complications such as psoas hematoma.
In the face of a global increase in dengue cases, awareness and preparedness at both the community and healthcare levels are paramount. The outlined case report demonstrates a rare but serious complication of dengue hemorrhagic fever and serves as a reminder of the critical necessity for comprehensive guidelines for the prevention, identification, and treatment of dengue and its complications, such as those provided by WHO (2011) and Riddell et al. (2016).
Ethical Considerations and Informed Consent
The Ethics review Committee of the Colombo South Teaching Hospital did not require ethical approval for the case report. However, the authors obtained written informed consent for publication that is available for review by the journal’s Editor, ensuring the ethical clearance for sharing this insightful and educational patient experience.
Conclusion
Through vigilance in patient management and increased awareness of unusual dengue complications, mortality can be prevented, especially in endemic areas where swift recognition of symptoms is life-saving. As the threat of dengue looms large globally, healthcare systems must equip themselves to deal with not only the typical presentations but also the rare and perilous complications that come along with this infectious disease.
References
1. Matthias, A.T., Sanduni, A.S., Epa, A.A., et al. A case report of dengue haemorrhagic fever complicated with psoas hematoma requiring blood transfusion. BMC Infect Dis 19, 385 (2019). doi: 10.1186/s12879-019-4023-2
2. Wijewickrama, A., Fernando, S., Bandara, J., et al. Emergence of a dengue virus serotype 2 causing the largest ever dengue epidemic in Sri Lanka. bioRxiv 329318; doi: https://doi.org/10.1101/329318
3. WHO. Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever. Geneva: World Health Organization, 2011.
4. Sellahewa, K.H. Haematological disturbances in dengue Haemorrhagic fever – its pathogenesis and management perspectives. Hematol Oncol Res. 2015;1(3):15–24.
5. Lin, C-F., et al. Autoimmune pathogenesis in dengue virus infection. Viral Immunol. 2006;19(2):127–132. doi: 10.1089/vim.2006.19.127
Keywords
1. Dengue Hemorrhagic Fever Complications
2. Psoas Hematoma Dengue
3. Blood Transfusion in Dengue
4. Severe Dengue Infection Management
5. Tropical Infections and Muscle Hematomas