Ref Number = PITIKA-ASPR0137
Muhammad Herdiono Erprakasya, Agnes Praptiwi
Dengue infection may manifest asymptomatic and symptomatic. Some symptomatic dengue infections follow an uncomplicated complications and unusual manifestations that are being reported as expanded dengue syndrome. Expanded dengue syndrome added into World Health Organization (WHO) classification system to incorporate this wide spectrum of unusual manifestations. We report a case of expanded dengue syndrome with appendicitis manifestation.
We report a case of a 12 years old who came to the hospital presented with high grade fever for 1 day, abdominal pain, diarrhea, and vomiting. From physical examination we found abdominal tenderness. In laboratory test, the results leucopenia. Third day after admission, clinical condition was decreased. There are shock sign with tachycardia and decreased of blood pressure, patient was admitted to intensive care. There was lower right quadrant abdominal tenderness in physical examination. Laboratory test on third days results thrombocytopenia, increase HCT >20% from baseline, positive NS-1 and leucopenia was still exist. Results from ultrasound there are hypoechoic mass in appendix that suggested appendicitis. 
The patient recovers with adequate intravenous fluid rehydration and symptomatic therapy. The patient finally discharged 8 day after admission, with better general condition, platelet count >100,000/mm3, and sign of appendicitis has been decreased. There was no surgical treatment to this patient.
We diagnosed the patient as a case of expanded dengue syndrome with appendicitis manifestation. Almost all cases of dengue infections are self-limiting and could be recovered by adequate intravenous fluid management and symptomatic therapy. Surgical therapy was no needed. Prompt investigation and timely diagnosis and treatment is very essential in reducing mortality associated with such cases.
Keywords: WHO, expanded dengue syndrome, abdominal tenderness, NS-1, appendicitis
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