Spontaneous septal hematoma: Dengue as a probable cause

Abstract

Spontaneous septal hematoma is a rare entity that can have serious consequences if not diagnosed and treated promptly. We present two cases of spontaneous septal hematoma in patients with no history of nasal trauma, the only history of which was Dengue infection. Hemorrhagic dengue can cause various complications due to thrombocytopenia and other coagulation disorders present during the disease. There is literature on spontaneous hematomas in other locations related to dengue, although they are rare manifestations. In the first semester of 2024, there was an exponential increase in Dengue cases in Córdoba. The ENT Department of the HNC received two cases of spontaneous septal hematoma. Both denied a history of nasal trauma.

CASE 1: Male, 23 years old, on day 5 of Dengue infection. He presented a sensation of sudden nasal obstruction, without any other accompanying symptoms. Laboratory thrombocytopenia: 104 m. CASE 2: Male, 44 years old, on day 10 of dengue infection (serological diagnosis H. Rawson), with nasal obstruction 4 days prior to consultation, sensation of an object in both nostrils, and fever, treated with antibiotics. Due to lack of response, he was referred to the HNC. Laboratory: thrombocytosis (platelets: 438 m). In both, wide surgical drainage was performed on 2 occasions followed by bilateral anterior compressive packing, in case 1 for 6 days and in the other for 10, due to recurrence of hematomas, plus antibiotic therapy. Complete resolution without sequelae with normalization of platelets in case 1 and resolution with scarring in the septal mucosa in the 2nd.

Drainage with aspiration of the hematoma together with anterior packing are the most effective therapeutic options. Bilateral recurrence of these infections is rare, so patients with dengue and septal hematoma should be monitored to prevent complications such as cartilaginous necrosis that leads to nasal deformities. The correlation between hemorrhagic dengue and spontaneous septal hematoma is possible based on the common pathophysiology. Although reports of septal hematoma in the context of dengue are limited, the presence of thrombocytopenia, coagulopathy, and increased vascular permeability may predispose to the formation of hematomas in various locations, including the septum.