Dengue Fever Complicated By Hemophagocytosis – A Difficult To Manage Case

Abstract

Dengue fever, which is transmitted by the mosquito Aedes aegypti is a common acute viral febrile illness, affecting 390 million people worldwide every year. It is endemic in several countries. Although the usual presentation is that of a self-limiting illness, its complications are protean. Infection Associated with Hemophagocytic Syndrome (IAHS) is a rare and fatal complication of dengue fever. It should be suspected in a patient with fever beyond seven days, associated with hepatosplenomegaly, hyperferritinemia, worsening cytopenias and development of multiorgan dysfunction(MOD). We report a 19-year-old female, who presented with an acute febrile illness and was diagnosed with primary dengue fever. Despite appropriate supportive therapy, she worsened clinically during the course of hospitalisation. A disproportionately high ferritin level and persistent bicytopenia prompted investigations for hemophagocytic lymphohistiocytosis (HLH). Further evaluation revealed features of HLH, as per the diagnostic criteria laid down by the Histiocyte Society. She was successfully treated with glucocorticoids, etoposide and intravenous immunoglobin and other supportive therapy. She had severe cytopenia and cardiac dysfunction during the course of her illness and its management. This case adds to the limited adult cases of dengue-associated hemophagocytic syndrome and shows its difficulty in management due to associated extra complications.