Despite what is in the textbooks Dengue patients do not always develop rashes till the platelet levels have fallen waay down and even then hemorrhage may be sudden. Today i saw a patient in emergency who was complaining of pain in right upper abdomen and had fever for last 2 days. I had a suspicion of liver abscess and to confirm i got a ultrasound examination done. The radiologist found inflammation of gallbladder without any stones suggestive of dengue and it was confirmed as such. Quite a number of patients present with upper abdominal pain with fever and it has happened quite a few times that on clinical examination i have suspicion of Acute cholecystitis which on ultrasound examination is suggestive of dengue and later confirmed as such. Discussion of dengue from surgical point of view can be seen here .