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Am J Trop Med Hyg. May 5, 2011; 84(5): 651–652.
PMCID: PMC3083728
Acute Dengue Fever with Computed Tomography (CT) Correlation
Helen C. Addley,* Lawrence Green, and Sophie Petitclerc
Department of Radiology, Montreal General Hospital, Montreal, QC, Canada; J. D. MacLean Centre for Tropical Disease, McGill University, Montreal, QC, Canada
*Address correspondence to Helen Addley, Department of Radiology, Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada. E-mail: helenclareaddley/at/hotmail.co.uk
Received December 18, 2010; Accepted January 25, 2011.
A 23-year-old female presented to the emergency department with vomiting and abdominal pain. She had traveled home to Canada the previous day from Indonesia and Thailand. Her symptoms had started 5 days previously in Bangkok with malaise and fever. On clinical examination she looked ill with a low-grade fever of 37.3°C. Cardiovascular, respiratory, and neurological examinations were normal. On examination, her abdomen was extremely tender with guarding of the right upper quadrant. A diffuse purpuric erythematous rash was noted over her extremities and trunk (Figure 1).
Figure 1.
Figure 1.
Purpuric rash on both legs. This figure appears in color at www.ajtmh.org.
Laboratory tests revealed a low platelet level at 34 with raised liver transaminases: aspartate aminotransferase 244 and alanine aminotransferase 111. Malaria smear was negative. Chest radiograph at initial presentation was negative but within 24 hours after the highest fever at 39.4°C showed moderate bilateral pleural effusions (Figure 2).
Figure 2.
Figure 2.
(A) Chest radiograph at initial presentation and (B) after 24 hours showing bilateral pleural effusions (white arrows).
Computed tomography (CT) of the abdomen showed a moderate amount of low-attenuation free fluid in the abdomen and pelvis with periportal edema and pericholecystic fluid (Figure 3).
Figure 3.
Figure 3.
Computed tomography (CT) of the abdomen including the lung bases (A) showed bilateral pleural effusions without evidence of pulmonary edema on lung windows (B). Moderate amount of free fluid seen in the upper abdomen (C, D) with periportal edema (white (more ...)
The combination of thrombocytopenia and imaging findings consistent with plasma leakage are suggestive of dengue hemorrhagic fever1; later confirmed on serology with both single IgG and IgM positive results. Imaging in assessment of fluid in multiple body compartments becomes detectable at the time of the immune response and typically at the time of disappearance of fever and is well demonstrated on both CT and ultrasound examinations.2
Footnotes
Authors' addresses: Helen C. Addley and Sophie Petitclerc, Department of Radiology, Montreal General Hospital, Montreal, QC, Canada, E-mails: helenclareaddley/at/hotmail.co.uk and sophie.petitclerc/at/muhc.mcgill.ca. Lawrence Green, J. D. MacLean Centre for Tropical Disease, McGill University, Montreal, QC, Canada, E-mail: laurence.green/at/muhc.mcgill.ca.
References
1. Schmidt AC. Response to dengue fever–the good, the bad and the ugly? N Engl J Med. 2010;363:484–487. [PubMed]
2. Srikiatkhachorn A, Krautrachue A, Ratanaprakarn W, Wongtapradit L, Nithipanya N, Kalayanarooj S, Nisalak A, Thomas SJ, Gibbons RV, Mammen MP, Jr, Libraty DH, Ennis FA, Rothman AL, Green S. Natural history of plasma leakage in dengue hemorrhagic fever: a serial ultrasonographic study. Pediatr Infect Dis J. 2007;26:283–290. [PubMed]
Articles from The American Journal of Tropical Medicine and Hygiene are provided here courtesy of
The American Society of Tropical Medicine and Hygiene