Case Reports

doi:10.7244/cmj.2015.06.001
KJ Bhat MD, HJ Samoon and R Shovkat

The clinical course of dengue haemorrhagic fever in the elderly is rather atypical and it is imperative to be aware of the protean manifestations and complications of dengue febrile illness in this age group. Rectus sheath haematoma, in the context of acute emergency presentations is uncommon, especially in the patients on anti-coagulation therapy. Bilateral  rectus sheath haematoma is rarely seen.

We present the first case of spontaneous and bilateral rectus sheath haematoma complicating dengue haemorrhagic fever in an elderly male. This case emphasizes the fact that serious complications can occur during the defervescence phase, especially in the elderly, and that a high index of supervision and suspicion should be maintained by the clincians.

doi:10.7244/cmj-1379800800-1
Shirley Sze

A 32-year-old from Turkey (Kurdistan province) presented with a 4-year history of recurrent, severe, vague abdominal pain requiring numerous hospitalizations. The pain was non-radiating, dull and constricting in nature with acute onset. There were no associated symptoms apart from constipation. His C-reactive protein and white cell count were always raised during these acute episodes. The pain resolved spontaneously without any specific treatment. He was completely well in between these acute episodes. Investigations including diagnostic laparoscopy, endoscopy and colonoscopy, CT scans and porphyria and infection screens were performed and were found to be negative / normal. Subsequent analysis of the MEFV gene detected two pathogenic variants (Met680IGC and Glu148Gln) on exon 2 and 10 and a diagnosis of familial Mediterranean fever was made. He had no further acute episodes after colchicine treatment was initiated.