Beyond Hemorrhage: A Case of Acute Dengue Infection Presenting with Budd-Chiari Syndrome and Bilateral Sensory Polyneuropathy.
Krushna Keshav Dalvi, Priya Khaire, Mohammed Hassan Shaik
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Case in brief
A 22-year-old man with dengue IgM positivity and thrombocytopenia presented with abdominal pain, fever, vomiting, and loose stools. Examination showed hepatomegaly and ascites; imaging demonstrated hepatic vein thrombosis, inferior vena cava narrowing, and caudate lobe hypertrophy, consistent with Budd-Chiari syndrome. Endoscopy found grade II esophageal varices. He also developed severe bilateral lower-limb pain, with nerve conduction studies confirming sensory polyneuropathy. Apparent deficiencies of protein C, protein S, and antithrombin III were not present on repeat testing after anticoagulation was stopped. With monitored anticoagulation and supportive care, thrombosis, ascites, and liver-function abnormalities resolved.
What made this case unusual
The case combined dengue-associated Budd-Chiari syndrome with bilateral sensory polyneuropathy, despite dengue being more commonly associated with hemorrhagic complications. Initial thrombophilia abnormalities proved transient on repeat testing.
Diagnostic / clinical pearl
In a patient with dengue and abdominal symptoms, hepatic venous thrombosis may underlie ascites and hepatomegaly; imaging established Budd-Chiari syndrome here. Severe limb pain also warranted neurological assessment, which identified sensory polyneuropathy.