Wunderlich Syndrome in a patient with dengue infection – An entity to remember

Dengue infection has become a serious public health concern. Dengue management protocols and the management of common complications arebeing updated often based on understanding the Pathophysiology of dengue infection. This understanding has definitely improved dengue management resulting in reduction in dengue deaths. At times, uncommon complications may be overlooked in busy and crowded clinical settings.  Spontaneous localized retro-peritoneal bleeding including bleeding into psoas muscle or Wunderlich Syndrome has been reported in few instances associated with dengue fever in this country and abroad. Thislife-threatening possibility must be born in mind when a clinician notices sudden deterioration of a dengue patient withoutsignificant thrombocytopenia, generalized bleeding manifestation or other evidence of extra vascular fluid loss. The management of this entity requires urgent restoration of the circulatory volume including urgent blood transfusion though, in general, clinicians are moreconcerned about fluid overload in the management of dengue patients.  As awareness of this entity seems poor, further research and reporting of similar cases in medical literature will shed more light on this obscure entity and increase the awareness among clinicians with favorable results.