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Year : 2014  |  Volume : 1  |  Issue : 3  |  Page : 201-202

Spontaneous muscle hematomas in a patient with Dengue hemorrhagic fever

1 Department of Medicine, Christian Medical College, Ludhiana, Punjab, India
2 Department of Radiology, Christian Medical College, Ludhiana, Punjab, India

Date of Web Publication17-Aug-2014

Correspondence Address:
Jency Maria Koshy
Department of Medicine, Christian Medical College and Hospital, Ludhiana - 141 008, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2348-3334.138905

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Dengue hemorrhagic fever (DHF) and Dengue shock syndrome manifest in various forms, ranging from petechial skin hemorrhage to life threatening cerebral, pulmonary, gastrointestinal and genitourinary hemorrhages. However it is very rare to have muscle hematomas in DHF. We report a rare case of spontaneous Iliopsoas hematoma complicating Dengue hemorrhagic fever.

Keywords: Dengue hemorrhagic fever, iliopsoas hematoma, muscle hematoma

How to cite this article:
Koshy JM, John M, Rathore S, George UB. Spontaneous muscle hematomas in a patient with Dengue hemorrhagic fever. CHRISMED J Health Res 2014;1:201-2

How to cite this URL:
Koshy JM, John M, Rathore S, George UB. Spontaneous muscle hematomas in a patient with Dengue hemorrhagic fever. CHRISMED J Health Res [serial online] 2014 [cited 2023 Apr 1];1:201-2. Available from: https://www.cjhr.org/text.asp?2014/1/3/201/138905

  Introduction Top

Dengue fever is caused by Dengue virus which belongs to the family flaviviridae. Dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) manifest in various forms ranging from petechial hemorrhages to life-threatening gastrointestinal, pulmonary, cerebral or genitourinary hemorrhages. However, it is rare to have muscle hematomas. We report a rare case of Iliopsoas muscle hematoma complicating DHF.

  Case Report Top

A 39-year-old gentleman, a resident of Punjab, came to our hospital with fever for four days associated with generalized malaise. He did not have any other localizing complaints. There was no history of bleeding from any site. Clinical examination revealed conjunctival suffusion, generalized blanching and hepatomegaly.

Initial investigation revealed leucopenia (3,100/mm 3 ) and thrombocytopenia (11,000/mm 3 ). The biochemical parameters were normal except for transaminitis (AST 66 IU, ALT 132 IU). His blood culture was sterile. Dengue IgM (Pan Bio capture ELISA) antibodies were detected in serum. Malarial parasites were absent on the peripheral blood film. Malarial antigens and antibodies against Leptospira were not detected.

He was given a single donor platelet transfusion. During his second day of hospitalization, he had a severe bout of cough, following which he experienced lower abdominal pain. Ultrasonography of the abdomen revealed hepatomegaly, reactionary cholecystitis and minimal ascites, which were consistent with features seen in DHF. Radiography of the abdomen was normal. His platelet counts were 13,000/mm 3 and it dropped to 12,000/mm 3 on the following day.

On the third hospital day, he complained of hip pain and had painful movements of both hip joints. Ultrasonography of both hips and pelvis revealed heterogeneous areas in the bilateral iliacus and left iliopsoas tendon. Magnetic resonance imaging (MRI) of the hip was done, which revealed hematomas in the bilateral iliacus and left iliopsoas muscle [Figure 1]. He was managed with platelet transfusions and analgesics. He had full-range of movement at the hip joint, within a week, and was discharged in a stable condition. The platelet counts gradually normalized (3.6 lakh/mm 3 ) by the tenth hospital day.
Figure 1: Axial T2 weighted image showing oval hematomas with perilesional oedema in the iliacus muscle bilaterally

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  Discussion Top

Muscle hematomas are a rare complication of dengue fever. Only very few cases have been reported in the literature of spontaneous muscle hematomas in DHF. Ammer et al., Ganeshwaran et al. and Ganu et al. reported cases of DHF with muscle hematomas in the psoas, rectus muscle and iliopsoas, respectively. [1],[2],[3]

Spontaneous hematomas have often been described in the thorax, abdominal cavity, retroperitoneum, muscle parenchyma and joints. They are usually associated with an underlying pathology like aneurysms, bleeding diathesis with oral anticoagulant therapy.

The common sites of intramuscular hematomas in the abdomen are the rectus sheath, psoas and iliacus muscles. Psoas hematomas have been reported in cases of disseminated intravascular hematomas, [4] post continuous ambulatory peritoneal dialysis, [5] post-traumatic [6] and rarely idiopathic. Most often they are unilateral and rarely are bilateral, symmetrical muscle hematoma reported as in this case. [7]

  Conclusions Top

Even though hemorrhages in major organs are common in DHF, spontaneous muscle hematomas are rare. Management is conservative with platelet transfusion and resolution occurs with time.

  References Top

1.Ammer AM, Arachichi WK, Jayasingha PA. Psoas hematoma complicating dengue hemorrhagic fever: A case report. Galle Med J 2009;14:83-4.  Back to cited text no. 1
2.Ganeshwaran Y, Seneviratne SM, Jayamaha R, De Silva AP, Balasuriya WK. Dengue fever associated with a hematoma of the rectus abdominis muscle. Ceylon Med J 2001;46:105-6.  Back to cited text no. 2
3.Ganu S, Mehta Y. Femoral compressive neuropathy from iliopsoas hematoma complicating Dengue haemorrhagic fever. Asian Pac J Trop Med 2013;6:419-20.  Back to cited text no. 3
4.Türk EE, Tsokos M. Iliopsoas muscle bleeding as a complication of septic disseminated intravascular coagulation. Virchows Arch 2003;443:106-7.  Back to cited text no. 4
5.Campisi S, Cavatorta F, De Lucia E. Iliopsoas spontaneous hematoma: An unusual cause of hemoperitoneum in CAPD patients. Perit Dial Int 1992;12:78.  Back to cited text no. 5
6.Weiss JM, Tolo V. Femoral nerve palsy following iliacus hematoma. Orthopedics 2008;31:178.  Back to cited text no. 6
7.Sasson Z, Mangat I, Peckham KA. Spontaneous iliopsoas hematoma in patients with unstable coronary syndromes receiving intravenous heparin in therapeutic doses. Can J Cardiol 1996;12:490-4.  Back to cited text no. 7


  [Figure 1]

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