Vol 44 # 2 June 2012 - Kma.org.kw

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145 Incomplete Small Bowel Obstruction Caused by Idiopathic Diaphragm Disease of the ... June 2012 this seems to be an appropriate management plan. In addition, the patient was fully informed of his final pathology to allow rapid assessment and management, should he develop signs of small bowel obstruction in future. CONCLUSIONS DD of the bowel is a rare condition. It should be considered in the differential diagnosis of intestinal obstruction in a virgin abdomen. Ingestion of NSAIDs has been associated with this disease although no history of NSAID ingestion was found in the case presented in this report. REFERENCES 1. Lang J, Price AB, Levi AJ, Burke M, Gumpel JM, Bjarnason I. Diaphragm disease: pathology of disease of the small intestine induced by non-steroidal antiinflammatory drugs. J Clin Pathol 1988; 41:516-526. 2. Roche JC, Morris-Stiff G, Champ C, Williams GT, Lewis MH. Colonic diaphragm disease without significant non-steroidal anti-inflammatory drug use: a case report. Cases J 2008; 1:247. 3. Fortun PJ, Hawkey CJ. Nonsteroidal anti-inflammatory drugs and the small intestine. Curr Opin Gastroenterol 2005; 21:169-175. 4. Santolaria S, Cabezali R, Ortego J, Castiella T, Salinas JC, Lanas A. Diaphragm disease of the small bowel: a case without apparent nonsteroidal anti-inflammatory drug use. J Clin Gastroenterol 2001; 32:344-346. 5. Moffat CE, Khyan MK, Davies CG, Ghauri AS, Ranaboldo CJ. Diaphragm disease: the limitation of laparoscopy and assessment of the small bowel for strictures using a ball bearing. Scientific World Journal 2006; 6:1139-1143.
June 2012 KUWAIT MEDICAL JOURNAL 146 Case Report Dengue Fever among Travelers Suha M AbdulSalam 1 , Muneera Y Al-Tarrah 2 , Faysal Alshalfan 3 1 Department of Medicine, Mubarak Al-Kabeer Hospital, Kuwait 2 Department of Medicine, Amiri Hospital, Kuwait 3 Department of Virology, Mubarak Al-Kabeer Hospital, Kuwait Kuwait Medical Journal 2012; 44 (2): 146 - 148 ABSTRACT Dengue fever, also known as break bone fever, is an acute life-threatening febrile illness, which usually occur in the tropical and subtropical areas. Travelers may both acquire and spread dengue virus infection. We report a case of Dengue fever in a traveler from an endemic area. In this case report, we will emphasize the clinical manifestations and diagnosis of dengue virus infection from other tropical diseases affecting people who have recently travelled. It is important that health care providers and travelers be aware of such infections for proper management and prevention. KEY WORDS: fever, mosquitos, tropical diseases INTRODUCTION Dengue fever is one of the tropical diseases reported by travelers [1] . It is transmitted by Aedes mosquito. Among 20 to 70 percent of 50 million travelers between industrialized countries to developing countries each year report some illness associated with their travel [1] . Although most illnesses are mild, 8 percent require medical care [2] . This depends on several factors. People who visit family and local homes have an increased chance of exposure to pathogens than tourists [1] . After an incubation period of seven days, dengue fever manifests as an influenza like illness with fever, headache, and myalgia. In 50 percent of the infected people, diffuse maculopapular rash and petechial rash develop. Other clinical manifestations include lymphadenopathy, mild respiratory and gastrointestinal symptoms, in addition to hemorrhagic manifestations [1,3] . Classic dengue fever in travelers is self limiting and rarely fatal. It may require hospitalization. We present a classic case of dengue fever in a traveler from an endemic area. CASE REPORT A 63-year-old Canadian male of Pakistani origin presented to our medical casualty with three days history of high-grade fever, vomiting and diarrhea, followed by altered mental status on the day of admission. He was known to be diabetic, hypertensive and was diagnosed to have bronchial asthma. His family had noted a decrease in his conscious level for one day before they sought medical advice. The patient had come back from Pakistan a week ago. There were no ill contacts at home. He gave history of a recent urinary tract infection that was treated in Pakistan. He also gave a history of anti-pyretic tablet consumption (eight pills over two days) to relieve his fever. On presentation, his temperature was 39.6 °C. His respiratory rate and heart rate were 20 breaths, 94 beats per minute respectively. His blood pressure was measured to be 153 / 85 mmHg. He was conscious, but drowsy and disoriented. He appeared jaundiced. His abdomen was distended secondary to a quickly developing ascites. A diffuse, non- blanching, confluent rash was present on his upper and lower limbs. (Fig. 1- 3) He had mild right upper quadrant tenderness. The rest of his physical examination was unremarkable. His laboratory work up revealed mild anemia, a hemoglobin of 120 g/l, and thrombocytopenia with a platelet count of 19,000. He had leucopenia with a WBC count of 2.1 x 109/ml. His coagulation profile was prolonged. During the patient’s stay in the hospital, he developed worsening of all his laboratory parameters. He developed a marked drop in his hemoglobin to 90 g/l. His liver function tests and liver enzymes were deteriorating. His total bilirubin (TBil) was 113 mmol/l, Aspartate Transaminase (AST) 2349 mmol/l, Alanine Transaminase (ALT) 1567 mmol/l, Gamma Glutamate (GGT) 191 mmol/l. His Albumin level was 27 g/l. Serial screen for tropical diseases such as malaria, typhoid fever and brucella was negative. An enzyme-linked immunosorbent assay (ELISA) Address correspondence to: Dr Suha AbdulSalam, PO Box 13467, 71955 Kaifan, Kuwait. Tel: +965 99816273, E-mail: Suha1305@gmail.com
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Vol 44 # 2 June 2012 - Kma.org.kw

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