Dengue infection is a mosquito-borne viral infection that remains an endemic disease in many countries, including Indonesia. Atypical manifestations of dengue infection have been increasingly reported which are now known as expanded dengue syndrome, with renal disorder being one of the least studied manifestations. We report an unusual case of expanded dengue syndrome manifested as glomerulonephritis with acute kidney injury to present an atypical presentation of expanded dengue syndrome in pediatric patient and elucidate the effect of dengue infection on the kidney.
A 15-year-old boy came to emergency room with a chief complaint of fever since 7 days ago, accompanied with diarrhea, nausea, abdominal pain, headache, and muscle pain. He also complained reddish-brown colored urine without any change in frequency or volume of urination. He had no hypertension. His physical examination revealed abdominal pain in the epigastric and right upper quadrant and costovertebral angle tenderness. Laboratory examination showed thrombocytopenia and elevated C-reactive protein with positive anti dengue Immunoglobulin G (IgG) and IgM, as well as elevated ureum and creatinine serum level. Urine microscopy showed hematuria and mild proteinuria. There was no elevation in Anti-streptolysin O (ASTO) level and the complement C3 level was normal. The anti-dsDNA level was also negative. Abdominal ultrasound showed bilateral glomerulonephritis and mild ascites. Diagnosis of dengue hemorrhagic fever with acute glomerulonephritis and acute kidney injury was made. He was managed with maintenance fluid, intravenous antibiotic, intravenous steroid, and supportive care. He recovered gradually and was discharged 8 days after admission.
Recognition of atypical dengue manifestations is important in early diagnosis to ensure effective treatment and reduce the morbidity and mortality of the disease.