Female patient, 22 years old, resident and coming from the city of Iquitos, with no morbid history.
The disease began (day 1) with fever, myalgia, bone pain, headache and retro-ocular pain.
e persistence of these symptoms on days 2 and 3, the patient consulted a health center where a dengue fever was diagnosed without warning signs, with rash, so paracetamol (500 mg three times a day) was prescribed.
In the context of the research project "Vigilance and etiology of acute febrile illness in Peru", the patient was asked to perform a venous blood sample to be sent to the laboratory of the Naval Medical Research Unit Six (NAM).
On the fifth day of the disease, moderate to severe colic abdominal pain was added, located in the epigastrium and right hypochondrium, associated with nausea and vomiting.
On days 6 and 7, symptoms increased in intensity and the patient consulted again.
She received intravenous hydration and analgesia; however, as she did not improve, she was hospitalized.
The patient was admitted in poor general condition, shaking, with a temperature of 37.6°C axillary, blood pressure 90/60 mmHg, respiratory rate 26 per min, and heart rate 98 beats/min showed generalized rash lymphadenopathy.
Abdominal palpation pain was predominant in the right hypochondrium and positive Murphy's sign.
Cardiopulmonary and neurological examination were normal.
The loop or turning test was negative.
Laboratory tests revealed ALT (aluminium aminotransferase) 180/ L, platelet AST 100,000 platelets aminotransferase 43%, total bilirubin 365 U/L, serum albumin 2.3918 mg/dl, total bilirubin/dl
Blood glucose, urea and serum creatinine were normal.
Initial serum amylase was 41 U/L. Hydration and symptomatic intravenous medication (hioscine, metamizole and dimenhydrinate) were continued.
On day 8 she no longer had fever, but abdominal pain and vomiting were even more severe.
Serum amylase 213 U/L and alkaline phosphatases were controlled 75.5 U (VN up to 270 U/L).
Abdominal ultrasound showed a small amount of ascitic fluid, pleural effusion, perivesicular edema and thickening of the gallbladder wall (8.5 mm), with no presence of lithiasis or visceromegaly.
On day 10 an abdominal CT was performed whose poor quality showed no further details of the gallbladder but allowed ruling out pancreatic involvement.
The loop test, performed on the same day, was positive.
The treatment was continued until day 12, when discharge was decided partial clinical improvement (decrease of pain absence of nausea and vomiting) with diagnosis of dengue fever and medical tapeworm fever and diarrhea.
Symptoms gradually decreased and control of ALT and AST was performed on day 25, 18 and 25 U/L, respectively.
1.
The analysis of the samples to rule out other infections were negative: leptospirosis (RPC), viral sclerosis (IgG), hepatitis B (HBsAg) and other arboviruses such as fever mayo virus IgM isolation
The thick smear for malaria was also negative.
The PCR for dengue was positive for dengue virus serotype 4.
