Ultrasound Findings of Plasma Leakage in Dengue Fever

Abstract

A 26-year-old male from Iquitos, Peru (urban, peri-jungle), presented with a 5-day history of fevers, headaches, and body aches. Three days before presentation, the patient started having diffuse abdominal pain, later localizing to the epigas-trium with associated nausea, vomiting, and scant hema-temesis. He also had increasing restlessness, insomnia, and constipation. Physical examination revealed temperature 36.8°C, heart rate 68 beats per minute, respiratory rate 21, and blood pressure 130/90. He was ill-appearing, with a diffuse blanching maculopapular rash, sparing the palms and soles, without evidence of petechiae (Figure 1). Car-diovascular and pulmonary examinations were unremark-able without evidence of dullness to percussion or crackles. Abdominal examination was notable for mild right upper quadrant and epigastric tenderness to palpation, without hepatosplenomegaly. He had no peripheral edema. Laboratory values were notable for a white blood cell count of 3,900 cells/mm 3 , hematocrit 45%, and platelets of 27,000 cells/mm 3. Transaminases were aspartate aminotransferase 208 (< 40 IU/L), alanine aminotransferase 124 (< 40 IU/L), and total bilirubin 1.