A 49-year-old female self-presented to an emergency department of a tertiary hospital in Hanoi Vietnam with severe right flank pain after being struck by a motorcycle as a pedestrian. Her medical background comprised chronic hepatitis B infection with no other known comorbidities. On examination, her Glasgow Coma Scale (GCS) was 15, blood pressure was 120/70 mmHg, oxygen saturations were 98% on room air, afebrile, respiratory rate 28 breathes/min, and heart rate 89 bpm. During ED assessment her blood pressure fell to 80/50 mmHg. Imaging revealed grade V right kidney injury, subcapsular laceration grade III liver injury, rib fracture of ribs 10, 11, and 12 on the right, and fractures of vertebrae T12 to L2 with no clinical evidence of spinal cord injury. Injury Severity Score was estimated to be 34.
She was given 2L of crystalloid, 2 units of fresh frozen plasma and 2 units of packed red cells in the emergency department before urgent transfer to the operating room for emergency trauma laparotomy with repair of descending duodenum (segment D2), formation of jejunostomy and right total nephrectomy followed by Intensive Care Unit admission.
On day 4 of admission, the patient developed a fever of 38.7 degrees Celsius which persisted to day 7, when her fever reached 40 degrees C despite prophylactic broad-spectrum antibiotics. During this time, her haemoglobin had dropped from 124 to 70 g/L, platelets from 368 to 62 g/L, white cell count decreased from 24.3 to 6.4 g/L, creatinine increased from 72 to 124 umol/L, urea from 8.8 to 20.8 mmol/L. Blood pressure in ICU dropped from 115/60 to 90/60 mmHg on day 7 of admission.
Dengue was suspected once she developed fever because of a concurrent seasonal epidemic of Dengue in Hanoi at the time and her NS1 antigen test returned positive for Dengue virus on day 4 post operation. IgM and IgG for Dengue were also positive. On day 7 she was diagnosed with DSS. She developed ascites and pulmonary oedema on day 10 which was treated with a trial of frusemide but subsequently became anuric on day 12 requiring continuous venovenous hemofiltration. The patient was extubated on day 19 of admission and transferred out of ICU the following day.