Dengue infection is well known to cause liver dysfunction, but acute pancreatitis is a rare complication. The simultaneous involvement of both organs is exceptionally rare and may mimic fulminant hepatitis, leading to delays in recognition and management. We report the case of a 34-year-old male who, on the 7 th day of dengue illness, developed progressive jaundice, pruritus, and severe epigastric pain. Laboratory evaluation showed markedly elevated transaminases (aspartate aminotransferase 10,083 IU/L; alanine aminotransferase 2,665 IU/L), direct hyperbilirubinemia (3.54 mg/dL), thrombocytopenia (87 × 10 9 /L), coagulopathy with an International Normalized Ratio (INR) 2.78, and a significant elevation in serum lipase (396 IU/L). Dengue NS1 antigen was positive, while other viral, autoimmune, and metabolic causes were excluded. Abdominal ultrasonography revealed hepatomegaly with fatty change and a mildly bulky pancreas, without biliary obstruction. A diagnosis of dengue-associated acute hepatopancreatitis with dengue-related coagulopathy was made. The patient was treated with intravenous fluids, proton pump inhibitors, analgesics, fresh-frozen plasma, and close monitoring of metabolic parameters. Clinical improvement was seen with resolution of jaundice, abdominal pain, and normalization of liver enzymes, lipase, and INR over the course of 5 days, after which he was discharged in stable condition. This case emphasizes the need to consider pancreatitis in dengue patients presenting with abdominal pain, even in the absence of conventional risk factors, as early recognition of this dual-organ involvement can prevent unnecessary interventions and improve outcomes.
Vihari et al. (Thu,) studied this question.