Septic shock mimicking dengue and typhoid: A case report

Abstract

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. 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. 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 Salmonella TUBEX was borderline positive, but both reverted to negative on repeat testing. The final diagnosis was culture-negative septic shock of presumed gastrointestinal origin with secondary acute pancreatitis. Fluid resuscitation, norepinephrine and vasopressin, empirical ceftriaxone, nutritional support, and conservative pancreatitis care. 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. In septic shock, an isolated reactive IgM should be interpreted cautiously and integrated with biomarker trends, cultures, and organ-dysfunction patterns.