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Abstract
Dengue is known to cause high morbidity and mortality worldwide. In recent years, there have been increasing cases of dengue fever associated with a rare complication: hemophagocytic syndrome (HPS), which is a dangerous disorder that carries high mortality. It is associated with infections, autoimmune disorders, and malignancies. Prolonged duration of fever and cytopenia together with multi-organ dysfunction out of proportion to the plasma leakage phase should alert clinicians to consider this condition. In this case study, we highlight a 45-year-old woman with underlying diabetes who was admitted due to dengue fever with warning signs. Her conditions deteriorated quickly: she had spontaneous bleeding, evidence of plasma leakage, severe hepatitis, and coagulopathy on the 11th day of illness. With the support of other blood results, such as raised serum ferritin and lactate dehydrogenase, she was diagnosed with severe dengue with hemophagocytosis syndrome. She responded well to intravenous dexamethasone and recovered on the 19 th day of illness.
Keywords:
dengue, fever, hemophagocytosis, lymphohistiocytosis
Introduction
Dengue has been recognized recently as one of the most significant public health threats, causing high morbidity and mortality worldwide. Although death due to dengue is 99% avoidable, every year around 20,000 deaths are estimated to occur in more than 100 countries.
One of the causes of severe dengue presentation is hemophagocytic syndrome. Hemophagocytic syndrome (HPS), or hemophagocytic lymphohistiocytosis (HLH), is a potentially fatal disorder caused by an abnormal immune response.1 Reactive HPS is associated with infections, autoimmune disorders, and malignancies. The infectious agents that have been previously linked with HPS are the Epstein-Barr virus, influenza virus, mycobacteria, cytomegalovirus, and human immunodeficiency virus, to name a few. In recent years, there have been increasing cases of dengue fever associated with HPS reported in the literature. However, this condition is still considered rare and under-recognized. Prolonged duration of fever and cytopenia together with multi-organ dysfunction out of proportion to the plasma leakage phase should alert clinicians to consider this condition.
This case illustrates a severe case of dengue infection with multi-organ dysfunction associated with hemophagocytosis syndrome, which was managed successfully due to early recognition of this condition.
Case presentation
We report a case of a 45-year old woman with underlying hypertension and diabetes mellitus who presented on day 5 of illness to the...