Septic shock mimicking dengue and typhoid: A case report
Sriwiwara Rawilase, AryatiRationale:
In dengue- and typhoid-endemic regions, a reactive IgM often anchors the diagnosis, yet severe sepsis can drive polyclonal B-cell activation and low-specificity antibodies that yield false-positive results.
Patient concerns:
A 57-year-old previously healthy male patient presented with six days of fever, crampy abdominal pain, and mucoid diarrhea, followed by progressive weakness and circulatory collapse.
Diagnosis:
Septic shock with multiple organ dysfunction (SOFA 10), thrombocytopenia, markedly raised procalcitonin, acute kidney injury, conjugated hyperbilirubinemia, and pancreatic edema. Dengue IgM was positive and
Interventions:
Fluid resuscitation, norepinephrine and vasopressin, empirical ceftriaxone, nutritional support, and conservative pancreatitis care.
Outcomes:
Cultures obtained after antibiotics were sterile; procalcitonin fell from 7.95 to 0.15 ng/mL by day 7, and the patient recovered and was discharged on day 13.
Lessons:
In septic shock, an isolated reactive IgM should be interpreted cautiously and integrated with biomarker trends, cultures, and organ-dysfunction patterns.