Atypical presentation of dengue fever in a G6PD deficient patient - a case report

Abstract

Dengue is a mosquito-borne viral disease that has rapidly spread in the recent years, particularly in South Asia. While haematologic complications, such as cytopenia and bleeding, may occur in severe dengue infection, reports of haemolytic anaemia in dengue fever are scant. We report a patient who developed haemolytic anaemia following dengue fever. A 45 years old gentleman presented with five-day history of fever and was recently diagnosed with dengue fever. He developed jaundice and started vomiting on the third day of his clinical course. His laboratory investigations revealed deranged liver profile, Coombs negative haemolytic anaemia and G6PD deficiency. He was treated conservatively with fluids and blood transfusions. His liver functions and haemolytic anaemia gradually resolved. This case highlights the importance of recognising dengue fever-induced haemolytic anaemia in a G6PD deficient patient by physicians and pathologists, enabling better diagnosis and improved management of this life-threatening condition.

Liver involvement in dengue: A systematic review

“…Epigastric 128 and bilateral 136,144 tenderness were also reported. Mostly present at admission, 91,136,137 pain worsened within 24–48 h before admission, 136,137 or at 4–8 days after illness onset 15,91,107,138 . Abdominal pain was more common in patients with SD 24,30,43,117,121 and was significantly associated with SD in large cohorts (approximatively 500 to 2000 patients) 98,122,124 (Table 1).…”

“…Jaundice was observed at admission in 17 studies 15,35,52,59,65,67,78,80,84,86,94,96,104,109,144,146,147 or appeared between day 4 and 11 of illness 52,56,58,59,62,67,78,91,94,107,138,141,146,148 and could resolve as late as 8 weeks after onset 95 . Jaundice developed progressively as liver enzymes increased 102 and worsened at 6–7 days after onset 52,107,148 .…”

“…In included studies, abnormal total bilirubin and direct bilirubin levels ranged from 3.4–50 mg/dL 15,16,34,54,56,58,63,65,67,78,80,93,95,96,102,107,133,135,138,140,141,144,147,162 and 3.9 to 37.5 mg/dL 43,58,78,80,102,133,135,138,144,147,148 respectively (Figure 2d). Bilirubin levels rose quickly between day 7 and 10 after onset 51,141,148 and maximum levels were recorded between day 4 and 14 15,16,57–59,103,104,135,138,148 . Although contradicted in one study with few patients (90), 42 total bilirubin levels were significantly higher in SD patients in studies comprising 45 to 238 patients, 35,38,77,82,117,119,126 and in patients with hepatomegaly 119 .…”

“…Abdominal pain was reported in patients included in 97 studies (58%), being either diffused 107,135 or occurring in the right upper quadrant, 15,16,43,68,77,91,101,104,109,128,135–143 which may be consistent with liver injury. Epigastric 128 and bilateral 136,144 tenderness were also reported.…”

“…respectively (Figure2d). Bilirubin levels rose quickly between day 7 and 10 after onset51,141,148 and maximum levels were recorded between day 4 and 14 15,16,[57][58][59]103,104,135,138,148. Although contradicted in one study with few patients (90),42 total bilirubin levels were significantly higher in SD patients in studies comprising 45 to 238 patients,35,38,77,82,117,119,126 and in patients with CAMPANA ET AL.…”