Acute appendicitis complicated by mass formation occurring simultaneously with serologically proven dengue fever: a case report

Abstract

IntroductionAcute abdomen and acute appendicitis are unusual clinical presentations that occur in dengue infection–caused illness. Lymphoid hyperplasia and mesenteric adenitis are possible explanations, although vasculitis in the pathology of dengue infection has not been reported. Authors of previous case reports have described mimicking of acute appendicitis discovered upon surgical treatment. Dengue virus has not been proven to cause acute appendicitis.Case presentationWe report a case of an 8-year-old Sinhalese boy who developed acute appendicitis during the acute phase of serologically confirmed dengue fever. Although abdominal pain, vomiting and right-sided tenderness were present at the time of admission, a diagnosis of acute appendicitis was considered only 18 hours later, when abdominal guarding and a well-defined mass in the right iliac fossa were detected clinically and ultrasonographically. Conservative management with intravenous antibiotics was successful.ConclusionIn areas where dengue is endemic, awareness of dengue viral infection as a non-surgical cause of acute abdomen, as well as its ability to mimic acute appendicitis, is important because unnecessary surgery-related morbidity can be decreased. However, delaying or missing the diagnosis of acute appendicitis can result in serious complications. This message is particularly relevant to clinicians, especially pediatricians and surgeons, who encounter large numbers of patients during dengue epidemics and run the risk of missing the diagnosis of acute appendicitis. Likewise, delaying or missing the diagnosis of dengue hemorrhagic fever can lead to dengue shock syndrome and even death. This case highlights the need for careful evaluation of each patient who presents with acute abdomen and dengue infection.

Acute appendicitis during the recovery phase of dengue hemorrhagic fever: two case reports

“…Lymphoid hyperplasia and mesenteric adenitis may also mimic acute appendicitis in dengue [ 16 ]. One of these reported children had enlarged multiple mesenteric lymph nodes in the first abdomen ultrasound, and subsequent ultrasound only showed ruptured acute appendicitis with abscess formation.…”

“…One potential etiology is lymphoid hyperplasia and mesenteric adenitis present in the febrile phase of dengue fever. The pathophysiological changes that occur during the onset of dengue hemorrhagic fever including systemic inflammatory response syndrome and plasma leakage are also likely to contribute to the development of acute abdomen including appendicitis [ 16 ]. Plasma leakage can result in an edematous appendix with luminal obstruction, promoting secondary bacterial infection and appendicitis [ 18 ].…”

“…Therefore, accurate diagnosis is important to avoid unnecessary surgical procedures to reduce mortality [ 18 ]. A previously reported child in Sri Lanka revealed an appendicular mass occurring simultaneously with dengue infection [ 16 ]. Both of these children were diagnosed to have acute appendicitis during the recovery phase of DHF.…”

Dengue Infections and the Surgical Patient

“…Supplemental Table S1 outlines the reports of acute appendicitis in dengue. [39][40][41][42][43][44][45][46] Six of the eight patients were male. Common clinical presentations include fever, abdominal pain mainly in the right lower quadrant, and tenderness.…”