Expanded Dengue Syndrome: A Case of Subarachnoid Haemorrhage, Cranial Diabetes Insipidus, and Haemophagocytic Lymphohistiosis

Abstract

Dengue fever is a mosquito-borne viral infection common in tropical countries with increasing incidence. The clinical manifestations can range from asymptomatic or mild infection to multiorgan failure. The latter is also called “Expanded dengue syndrome,” and it carries a high rate of mortality and morbidity. Intensive care management of such complicated cases is a challenging task for the treating physician, which requires intense monitoring and a multidisciplinary approach for decision making. We report an atypical case of an expanded dengue syndrome presented with subarachnoid haemorrhage associated with moderate thrombocytopenia, cranial diabetes insipidus, and haemophagocytic lymphohistiosis in a young healthy female patient.

Spontaneous haemorrhagic stroke associated with expanded dengue syndrome: a case report

“…However, there are other studies that suggest that NS1 antigen may still be detectable until day 14. 5,8 Intracranial haemorrhage due to DHF is rarely reported. Intracerebral haemorrhage, subarachnoid haemorrhage and subdural haemorrhage have been reported.…”

“…Haemorrhage with a normal clotting profile may occur due to defects in platelet function that are known to occur in dengue infection. 8,12 Factors such as old age, high haematocrit, low platelet count, prolonged APTT, female gender, high absolute lymphocyte count, and elevated aspartate aminotransferase/SGOT are associated with severe bleeding in dengue patients. 11 In this case, an 86year-old patient with a decrease in platelet levels to <50,000 is a high risk factor for bleeding due to thrombocytopenia in DF.…”