Spontaneous retroperitoneal hematoma – An unusual presentation in a child with dengue fever

Background: Dengue fever is a syndrome caused by several arthropod-borne viruses, characterized by fever, myalgia or arthralgia, rash & thrombocytopenia. Various bleeding manifestations of dengue have been documented including petechiae, mucosal bleeding, pulmonary, GI, and cerebral hemorrhage. Abdominal hematoma presenting as acute abdominal pain is a rare complication of dengue fever and is frequently overlooked. There is a paucity of data in the current literature on such cases. A 13-year-old male was admitted with a complaint of fever for 3 days and myalgia. The patient had hepatosplenomegaly and managed as dengue with warning signs with positive NS1 antigen and dengue IgM antibody Platelet count was 42×103/mm3. No history of any bleeding disorder, trauma, or exposure to anticoagulant drugs. On day 6 of admission, the patient developed acute pain in the right lumbar and inguinal region, along with a reduced ability to move the right leg. Hip joint movements on the right side were painful with no restriction. Management & Outcome: His coagulation profile was normal with a hemoglobin value of 10.5 g/dl and platelet count of 40×103/mm3. CECT abdomen- suggestive of retroperitoneal collection of fluid adjacent to right psoas muscle – consistent with retroperitoneal bleed.He was monitored, managed conservatively & showed gradual improvement. Platelet counts improved. Discharged at platelet count of 273×103/mm3 & when symptom-free.On follow-up after a month, he was asymptomatic. The possibility of a retroperitoneal hematoma should be considered in a case of unexplained lower abdominal pain & hip arthralgia with dengue fever. A high index of clinical suspicion and awareness can detect such cases with needful management.