Case report: spontaneous rupture of the spleen due to dengue fever

Miranda, Luíz Bruner de; Miranda, Sergio; Rolland, Morgane

doi:10.1590/s1413-86702003000600011

Cited by 21 publications

(23 citation statements)

References 5 publications

(5 reference statements)

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“…Splenic rupture and hepatosplanchnic circulatory dysfunction have occasionally been reported in patients who succumb to DHF/DSS (17,32). Based on our presented data, it is tempting to postulate that this is caused by a sequence of events.…”

Section: Discussionmentioning

confidence: 62%

Primary Human Splenic Macrophages, but Not T or B Cells, Are the Principal Target Cells for Dengue Virus Infection In Vitro

Blackley¹,

Kou²,

Chen³

et al. 2007

J Virol

103

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Understanding the pathogenesis of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) requires the precise identification of dengue virus (DV)-permissive target cells. In a previous study using unfractionated human peripheral blood mononuclear cells, we found that monocytes, but not B or T cells, were the principal DV-permissive cells in the absence of DV-immune pooled human sera (PHS) and the major mediators of antibody-dependent enhancement in the presence of PHS. To further identify DV-permissive target cells in other tissues and organs, we isolated human splenic mononuclear cells (MNCs), inoculated them with DV type 2 (strain 16681) in the presence or absence of PHS, and assessed their infection either directly using flow cytometry and reverse transcription-PCR (RT-PCR) assays or indirectly by plaque assay. We found that in the absence of PHS, a small proportion of splenic macrophages appeared to be positive for DV antigens in comparison to staining controls by the flow cytometric assay (0.77% ؎ 1.00% versus 0.18% ؎ 0.12%; P ‫؍‬ 0.07) and that viral RNA was detectable by the RT-PCR assay in MNCs exposed to DV. Additionally, supernatants from cultures of DV-exposed MNCs contained infectious virions that were readily detectable by plaque assay. The magnitude of infection was significantly enhanced in splenic macrophages in the presence of highly diluted PHS (5.41% ؎ 3.53% versus 0.77% ؎ 1.00%; P ‫؍‬ 0.001). In contrast, primary T and B cells were not infected in either the presence or absence of PHS. These results provide evidence, for the first time, that human primary splenic macrophages, rather than B or T cells, are the principal DV-permissive cells in the spleen and that they may be uniquely important in the initial steps of immune enhancement that leads to DHF/DSS in some DV-infected individuals.

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Section: Discussionmentioning

confidence: 62%

Primary Human Splenic Macrophages, but Not T or B Cells, Are the Principal Target Cells for Dengue Virus Infection In Vitro

Blackley¹,

Kou²,

Chen³

et al. 2007

J Virol

103

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“…Only anecdotal case reports have been documented to have splenic rupture in DF. [5678] Of the 11 dengue cases describing splenic rupture, eight (out of 11) patients have survived. The survival observed in these cases should be attributed to timely diagnosis and management rather than the natural course of splenic rupture, which is expected to be poor if the diagnosis is missed.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous splenic rupture: A rare presentation of dengue fever

Mukhopadhyay¹,

Chatterjee²,

Maity³

et al. 2014

Indian Journal of Critical Care Medicine

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Spontaneous rupture of the spleen with hemoperitoneum is a very rare, but serious manifestation of dengue fever (DF). We report a case of a young female who was presented with atraumatic abdominal pain, hypovolemic shock, anemia, ascites and hepatosplenomegaly with a recent history of a febrile illness. Subsequent investigations proved the presence of hemoperitoneum with spontaneous splenic rupture with seropositivity for DF. Early diagnosis and conservative management in this case resulted in a favorable outcome.

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“…There are various theories of the pathogenesis of DHF/DSS, such as increase in vascular permeability, perivascular edema, vascular endothelial injury and parenchymal necrosis with splenic hyperplasia. [5] Bleeding manifestations in dengue illness are multifactorial. A combination of (a) increased prothrombin time, (b) hemoconcentration, (c) platelet count of less than 50,000 cells/mm 3 and (d) elevated alanine transaminase (ALT) is known to be predictive for spontaneous bleeding manifestations.…”

Section: Discussionmentioning

confidence: 99%

“…Although up to 100 million cases of dengue fever are registered per year only a few reports of hemoperitoneum are seen in the literature. [5]…”

Section: Discussionmentioning

confidence: 99%

Hemoperitoneum in dengue fever with normal coagulation profile

Chandrashekar

Krishnappa

Reddy

et al. 2013

J Global Infect Dis

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A 43-year-old male living in Bengaluru sought emergency services due to high-grade fever, headache, myalgia, abdominal pain and distension. Platelet count (except the first-96,000/mm3) and coagulation profile was in normal limits. The dengue serology was positive for IgM and Ig G (immunoglobulin M and G) antibodies. Ultrasound abdomen showed gross ascites, mild bilateral pleural effusion and hepatosplenomegaly. The patient continued to have abdominal pain and progressive distention Ascitic tap was hemorrhagic. Later laparoscopy showed 1.5 liters peritoneal fluid with blood clots and mild diffuse congestion of the peritoneum. Liver, spleen and blood vessels were normal. Then what would be the possible mechanism to explain hemoperitoneum, is it the increased vascular permeability caused by the virus? India being endemic for dengue illness, it is an interesting and rare case presentation.

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Case report: spontaneous rupture of the spleen due to dengue fever

Cited by 21 publications

References 5 publications

Primary Human Splenic Macrophages, but Not T or B Cells, Are the Principal Target Cells for Dengue Virus Infection In Vitro

Primary Human Splenic Macrophages, but Not T or B Cells, Are the Principal Target Cells for Dengue Virus Infection In Vitro

Spontaneous splenic rupture: A rare presentation of dengue fever

Hemoperitoneum in dengue fever with normal coagulation profile

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