An unusual case of dengue shock syndrome complicated by ilio-femoral deep vein thrombosis; a case report

Abstract

Background: Dengue fever is a hemorrhagic fever caused by flaviviruses. Hemorrhagic manifestations are well known to be associated with dengue fever, though the thrombotic events are only seldom reported. Underlying pathophysiology of thrombotic events is multifactorial and the management is challenging due to associated thrombocytopenia and bleeding tendency. We report a case of dengue shock syndrome with severe thrombocytopenia complicated by ilio-femoral deep vein thrombosis. Case presentation: A 16 year old boy presented with dengue fever. He had dengue shock syndrome after entering the critical phase on the fifth day of the illness. With the recovery from the critical phase he developed deep vein thrombosis involving right external iliac, common femoral and superficial femoral veins. There were no provocative factors other than dengue fever itself. His platelet count was 12,000/μl at the time of diagnosis with deep vein thrombosis. Anticoagulation was started with intravenous unfractionated heparin 500 IU/hour while closely being observed for bleeding complications. 1000 IU/hour dose was commenced with the recovery of the platelet count above 50,000/μl. Thrombophilia screening was negative and he was discharged on warfarin. Venous duplex done after 6 weeks showed normal lower limb venous flow and warfarin was omitted after three months. Conclusions: With dengue fever, complications like deep vein thrombosis can be easily missed given its rarity and that the major concern is on hemorrhagic complications. Management is challenging due to associated thrombocytopenia and hemorrhagic complications.

Von Willebrand factor with increased binding capacity is associated with reduced platelet aggregation but enhanced agglutination in COVID-19 patients: another COVID-19 paradox?

“…Platelets exhaustion/clearance is a possible mechanism since it is likely that platelets are hyper-activated in the initial stage of COVID-19 disease and then become hyporeactive in the later stages. Noteworthy, also in some cases of dengue fever infection a prothrombotic status was described in the initial stage of the infection [ 10 ]. Another mechanism leading to reduced platelet aggregation may rely on higher concentrations of VWF, which may bind to platelet receptor for fibrinogen thus reducing aggregation.…”

A perfect storm: acute portal vein thrombosis in a patient with severe dengue and hemorrhagic manifestations—a case report

“…Da Costa et al reported an incidence of 5.4% thrombotic events in patients with severe dengue with a total of 5 venous thrombotic events, 4 of the cases were DVT and 1 mesenteric venous thrombosis; nonetheless, it was not an isolated event since concomitantly Escherichia coli bacteremia, a well-known risk factor for portal vein thrombosis, was diagnosed [ 4 ]. Other thrombotic events associated with dengue described in the literature are mainly cerebral venous thrombosis and DVT; in many of these cases, an associated procoagulant factor was not found either [ 5 , 6 ].…”

“…The clinical manifestations of the disease can range from mild symptoms to more severe but infrequent manifestations such as septic shock and coagulation disorders [3], where hemorrhagic events predominate. Cases of thrombosis are exceptional and only a few have been reported in the literature [4][5][6].…”

The Identification of Potential Drugs for Dengue Hemorrhagic Fever: Network-Based Drug Reprofiling Study

“…The network-based analysis suggested that 3 drugs have repurposable properties: aspirin, captopril, and rilonacept; however, because of their anticoagulant qualities, patients should be encouraged to be properly hydrated and avoid aspirin (ie, acetylsalicylic acid), aspirin-containing medicines, and other nonsteroidal anti-inflammatory drugs, such as ibuprofen [30]. On the other hand, several studies have reported that thrombosis is associated with dengue fever [32,33]; hence, further studies are essential to prove the efficiency of aspirin and the other repurposed drugs identified in this study for the treatment of DHF.…”