# Atypical Hemorrhages Secondary to Dengue Infection and Cardiopulmonary Resuscitation: Subcutaneous Thrombin Injection as a Salvage Technique for Refractory Femoral Artery Hemorrhage

## TL;DR

A case of severe dengue with unusual bleeding was successfully treated using subcutaneous thrombin injection and embolization techniques.

## Contribution

This paper presents a novel salvage technique using regional thrombin injection for managing refractory femoral artery hemorrhage in dengue patients.

## Key findings

- Atypical hemorrhage from psoas muscle and femoral arterial puncture sites occurred in a dengue patient.
- Large calibrated Gelfoam particle embolization successfully treated the psoas hemorrhage.
- Regional thrombin injection effectively managed the refractory femoral artery hemorrhage.

## Abstract

Dengue fever is a viral infection transmitted by the bites of female Aedes mosquitoes. Repeat infections with different viral serotypes are possible, with an increased risk of severe dengue. Dengue hemorrhagic fever is one of the most severe presentations of dengue, with thrombocytopenia, increased capillary permeability with resultant rash, and an increased risk of spontaneous bleeding. The management of severe dengue is done through supportive care and symptomatic management only, as there are no specific treatments available. We describe a case of severe dengue hemorrhagic fever presenting with atypical hemorrhage from both the psoas muscle and the femoral arterial puncture sites. These were successfully treated with large calibrated Gelfoam particle embolization for the psoas hemorrhage and regional thrombin injection for the femoral arterial puncture sites.