# Atraumatic Spleen Rupture: A Rare Fatal Complication of Dengue Hemorrhagic Fever

## TL;DR

This paper reports two rare cases of spleen rupture without trauma in patients with severe dengue, highlighting the challenges in managing such life-threatening complications.

## Contribution

The paper presents two rare clinical cases of atraumatic splenic rupture in dengue hemorrhagic fever, emphasizing management strategies and outcomes.

## Key findings

- Atraumatic splenic rupture can occur in dengue hemorrhagic fever without external injury.
- Non-operative management was successful in one patient but failed in another despite aggressive interventions.
- Clinical response during resuscitation influenced the decision for conservative versus interventional management.

## Abstract

Dengue is a common tropical infection in Southeast Asian countries, with clinical severity ranging from a self-limited acute febrile illness lasting 3-5 days to severe disease with a wide spectrum of complications. These complications can include extensive shock, coagulopathy, hemorrhage, multi-organ dysfunction, and death.

In this case report, we describe two cases of atraumatic splenic rupture occurring in the context of dengue hemorrhagic fever. In these two patients, non-traumatic rupture of the spleen occurred in the absence of any external injury, with positive dengue signs and serology. The major clinical challenges in managing these patients were hypovolemic shock, thrombocytopenia, and coagulopathy. Both cases were managed non-operatively, with an emphasis on organ preservation.

The first patient responded well to aggressive resuscitative efforts, was closely monitored for clinical deterioration, and was eventually discharged home in stable condition. The second patient presented with cardiac arrest and required intensive management, including invasive ventilation, massive transfusions, continuous renal replacement therapy, and splenic artery embolization to control bleeding. Despite these interventions, he unfortunately succumbed to the illness.

Effective source control is a critical component of resuscitation in hemorrhagic shock, but the decision to intervene surgically or conservatively must be individualized. Although both patients had similar baseline characteristics, except for differences in their hospital presentations, the choice between a more conservative approach and a liberal approach, such as interventional management, depended on their respective clinical responses during resuscitation.