Spontaneous splenic rupture during the recovery phase of dengue fever

Abstract

BackgroundSpontaneous splenic rupture is a rare but known complication of dengue fever. Previously reported cases have occurred early during the course of the disease and most cases have led to a fatal outcome. Here we report a case of spontaneous splenic rupture in a patient with dengue fever, which occurred during the recovery phase of the illness.Case presentationA 28-year-old Sinhalese, Sri Lankan man presented with a history of fever, myalgia and vomiting of 4 days duration. Investigations revealed a diagnosis of dengue fever with no signs of plasma leakage. He was managed in the ward as per local protocol. During the recovery phase the patient developed severe abdominal distention with circulatory failure. Radiology revealed splenic rupture with massive amounts of abdominal free fluid. The patient was resuscitated and Emergency laparotomy with splenectomy was performed. The outcome was excellent with the patient making a complete recovery.ConclusionAlthough splenic rupture is a known complication of dengue fever it may be manifested late in the disease process. A high degree of suspicion should be maintained and patients must be monitored even during the recovery phase of dengue fever. Early diagnosis and intervention can prevent mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1234-5) contains supplementary material, which is available to authorized users.

Systematic review of spontaneous splenic rupture in dengue‐infected patients

“…Most of splenic rupture cases were confirmed by contrasted or plain CT scan for acute abdominal symptoms ( n = 11; 64.7%), immediate CT in ( n = 9; 52.9%), and delayed CT in ( n = 2; 11.8%) (Table ). The major findings were persistent evidence of free fluid in peritoneal cavity (ascites) or hemoperitoneum ( n = 8; 72.7%), splenic hematoma or adherent thrombus ( n = 5; 45.5%), ruptured spleen ( n = 3; 27.3%), subcapsular hematoma ( n = 3; 27.3%), per‐capsular/per‐splenic effusion ( n = 3; 27.3%), and splenomegaly ( n = 3; 27.3%) …”

“…level was 25.6% (range: 12.2%‐49.8%, data available in 12 cases), while the median hemoglobin was 8.8 g/dl (range: 3.4‐14.3) (Table ). Coagulation profiles (prothrombin time and partial thromboplastin time) were reportedly in the normal range of three cases, while in one case, they were prolonged…”

Splenectomy in non-traumatic diseases

“…6,7 Most splenic cystic lesions are benign and distinguished from cystic metastasis by the absence of solid components, they are usually diagnosed by imaging tests. 7 Splenectomy laparotomy has been the method of choice for the treatment of many splenic cysts.…”

“…6,7 Most splenic cystic lesions are benign and distinguished from cystic metastasis by the absence of solid components, they are usually diagnosed by imaging tests. 7 Splenectomy laparotomy has been the method of choice for the treatment of many splenic cysts. Their removal is recommended in symptomatic cases, when they are bigger than 5cm or are susceptible to spontaneous rupture, due to its complications and because conservative treatment options do not result in good long-term control.…”

“…In imaging studies, particularly abdominal tomography, four different patterns of involvement of splenic lymphoma have been described: diffuse infiltration, where the entire spleen is affected by the tumour and manifests splenomegaly without large solid masses; small, focal infiltration or miliary nodules; infiltration with large multiple confluent nodular lesions and with bulky solid masses. 7 In cases of symptomatic splenomegaly and hypersplenism, stage of disease, patient's performance status, patients refractory to polichemotherapy associated Rituximab, which represents the treatment in PSL; splenectomy may be recommended, in selected cases as a rescue therapy. It relieves symptoms and ameliorate quality of life.…”