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All Journal Archives of The Medicine and Case Reports
I Ketut Suryana
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Health Professions Medicine & Pharmacology Nursing Public Health

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When Dengue and Lupus Collide: A Case Report of Overlapping Symptoms Leading to Diagnostic Delay Kadek Nova Adi Putra; I Ketut Suryana
Archives of The Medicine and Case Reports Vol. 6 No. 2 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i2.693

Abstract

Systemic lupus erythematosus (SLE) and dengue fever are two distinct diseases with overlapping clinical presentations, posing diagnostic challenges, especially in tropical regions where dengue is endemic. This case report describes a patient initially diagnosed with dengue fever who was later found to have SLE, highlighting the importance of considering SLE in the differential diagnosis of fever and thrombocytopenia even during dengue outbreaks. A 52-year-old female presented with fever, thrombocytopenia, arthralgia, myalgia, and a rash. She was initially diagnosed with dengue fever based on her clinical presentation and the prevalence of dengue in her community. However, her condition did not improve with supportive treatment, and she developed new symptoms, including shortness of breath and pleural effusion. Further investigations revealed a positive antinuclear antibody (ANA) test, leading to a revised diagnosis of SLE. The patient responded well to corticosteroid therapy and was discharged after seven days. In conclusion, this case underscores the importance of maintaining a broad differential diagnosis when evaluating patients with fever and thrombocytopenia in dengue-endemic areas. A high index of suspicion for SLE is crucial, even during dengue outbreaks, to ensure timely diagnosis and appropriate management.
Methylprednisolone as a Novel Adjuvant Therapy for Acute Cholecystitis with Non-obstructive Jaundice: A Case Report Ni Made Aryani; I Ketut Suryana
Archives of The Medicine and Case Reports Vol. 6 No. 2 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i2.694

Abstract

Acute cholecystitis is a common inflammatory condition of the gallbladder, primarily caused by gallstones or infection. While jaundice is often associated with acute cholecystitis due to biliary obstruction, it can also occur without evidence of obstruction, posing a diagnostic and therapeutic challenge. This case report presents a patient with acute cholecystitis and non-obstructive jaundice who demonstrated a remarkable response to methylprednisolone therapy. A 25-year-old male presented with a three-week history of right upper quadrant abdominal pain, jaundice, nausea, gray-colored stools, and dark urine. Physical examination revealed icterus, right upper quadrant tenderness, and a positive Murphy's sign. Laboratory investigations showed elevated total and direct bilirubin levels, transaminitis, and an increased gamma-glutamyl transferase (GGT) level. Abdominal ultrasonography confirmed acute cholecystitis with sludge but no biliary obstruction. The patient was treated with intravenous fluids, antibiotics, and supportive care. On the fourth day of hospitalization, methylprednisolone (62.5 mg twice daily) was initiated due to persistent jaundice and transaminitis. The patient's clinical and laboratory parameters improved significantly following the initiation of methylprednisolone. In conclusion, this case suggests that methylprednisolone may be a valuable adjuvant therapy for acute cholecystitis with non-obstructive jaundice, particularly in cases with evidence of liver and bile duct inflammation. Further studies are needed to confirm these findings and establish the optimal dosage and duration of methylprednisolone therapy in this setting.
Co-Authors Kadek Nova Adi Putra Ni Made Aryani