A Curious Case of Afebrile Dengue
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The present case has been published in the Journal of the Association of Physicians of India.

A 50-year-old male with complaints of fatigue for a few hours while on duty. He was a known diabetic, secondary to chronic calcific pancreatitis, on oral anti-diabetic drugs since last 12 years. He was advised insulin on multiple visits previously but he never complied. He was hemodynamically stable at the time of presentation but was found to have uncontrolled sugars (>700 mg/dl) and high anion gap metabolic acidosis.

With a diagnosis of diabetic ketoacidosis (DKA), he was managed with intravenous fluids and insulin. His sugars were corrected within 24 hours of presentation and he was switched to subcutaneous insulin. On routine investigation, he was found to have pancytopenia, elevated liver enzymes and deranged kidney function.

His urine routine showed 3-9 pus cells/ high power field but the cultures were sterile. Chest X-ray was clear. Procalcitonin levels were less than 0.5 ng/ml. Vitamin B12 and folic acid levels were normal. His platelet count fell to 12,000/ cu.mm in two days of admission.

Further evaluation for hematological and biochemical derangements uncovered positive dengue test (NS1 antigen and polymerase chain reaction assay). Patient distinctively reported no history of fever and remained afebrile during the course of illness. The authors report this case to highlight the possibility of afebrile dengue in endemic areas.

Read in detail about the case here: http://www.japi.org/august_2018/19_cotm_A Curious Case of.html
Dr. R●●●l K●●l and 5 others like this
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