BackgroundDengue fever is a common mosquito borne viral fever in South Asia, which causes significant morbidity and mortality. Dengue fever is well known to involve the liver, especially in dengue hemorrhagic fever. The hepatic involvement is usually that of a mild hepatitis with transaminase derangement without jaundice. In cases of dengue hemorrhagic fever where shock has ensued, a severe hepatitis with gross derangements of transaminases and bilirubin may occur. These are two rare cases of adult patients with dengue hemorrhagic fever presenting with a cholestatic type of jaundice.Case presentationThis case report describes two female patients aged 30 and 46 years who presented with fever, icterus and biochemical analysis revealed cholestatic jaundice. Evolution of the clinical picture and dropping platelets prompted serological investigations in the form of dengue non-structural protein 1 antigen and dengue immunoglobulin M which confirmed acute dengue infection.ConclusionThese cases highlight the importance of considering dengue fever as a differential diagnosis even in the presence of a cholestatic jaundice, especially in countries where dengue fever is endemic, and in travelers returning from dengue endemic countries. The early diagnosis of dengue fever and timely institution of supportive fluid management is essential to prevent morbidity and mortality.
Crohn's disease (CD) is one of the two types of inflammatory bowel disease (IBD) characterized by immunemediated granulomatous bowel inflammation leading to a variety of intestinal and extra-intestinal manifestations. Although gastrointestinal endoscopy remains an important investigation in macroscopic diagnosis, the subgroup of 20-30% patients with small bowel-limited disease does not benefit either from endoscopy or barium studies. We report a case of a young Sri Lankan male who presented with long term malabsorption and chronic hypoalbuminemia, extensively investigated for the underlying cause and finally being diagnosed to have small bowel Crohn's disease following wireless video capsule endoscopy. The case highlights the fact that with the advent and increased use of wireless capsule endoscopy, a better alternative is available for evaluating suspected small bowel CD without radiation exposure and its use should be made popular among the clinicians since the facility is available in the government sector and the prevalence of IBD is found to be significant in the local population than it was once thought to be.
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