New Onset Diabetes Mellitus in Dengue Shock Syndrome: a case
The present case study appears in the Journal of the Association of Physicians of India.

Two patients aged 30 years and 39 years were admitted in intensive care unit with history of fever and shortness of breath. No history of alcoholism was found. Patients were diagnosed with dengue fever as the NS1 antigen and dengue IgM antibody was positive. RT-PCR for dengue was positive in both patients .

Echocardiography was normal. Ultrasound abdomen revealed bulky and hypoechoic pancreas indicative of pancreatitis, fatty liver and ascites.

CT abdomen revealed diffusely enlarged pancreas with scattered non enhancing areas suggestive of necrosis, extensive peripancreatic fat stranding, moderate ascites and bilateral pleural effusion. On admission random blood sugars were high(>200mg/dl) in both patients without any history of diabetes mellitus.

Glycosylated hemoglobin levels were 5.1 and 5 for both patients. Patient were diagnosed as severe dengue hemorrhagic fever with acute pancreatitis, new onset diabetes mellitus, acute kidney injury, and decompensated shock. Patient were discharged after repeat ultrasound abdomen showing reduction of pancreatitis and ascites.

Acute pancreatitis diagnosis was based on clinical features, history of epigastric pain, fever, abdominal tenderness, enlargement of the pancreas on ultrasound examination and CT abdomen with normal hepatobiliary function, increased serum amylase and lipase 3 times above normal. Acute pancreatitis causing diabetes mellitus is a very rare manifestation of dengue. The exact mechanism of pancreatitis is not clear and was thought to be multifactorial.

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