Hemophagocytic syndrome in classic dengue fever

Abstract

A 24-year-old previously healthy girl presented with persistent fever, headache, and jaundice. Rapid-test anti-dengue virus IgM antibody was positive but anti-dengue IgG was nonreactive, which is suggestive of primary dengue infection. There was clinical deterioration during empiric antibiotic and symptomatic therapy. Bone marrow examination demonstrated the presence of hemophagocytosis. Diagnosis of dengue fever with virus-associated hemophagocytic syndrome was made according to the diagnostic criteria of the HLH 2004 protocol of the Histiocyte Society. The patient recovered with corticosteroid therapy. A review of literature revealed only a handful of case reports that showed the evidence that this syndrome is caused by dengue virus. Our patient is an interesting case of hemophagocytic syndrome associated with classic dengue fever and contributes an additional case to the existing literature on this topic. This case highlights the need for increased awareness even in infections not typically associated with hemophagocytic syndrome.

Dengue infection associated hemophagocytic syndrome: Therapeutic interventions and outcome

“…Secondary dengue infection (two sequential infections by different serotypes) is also a risk for severe dengue. However, we and others [3,4,12,[16][17][18] observed that primary dengue infections were as much at risk of severe DHF and dengue associated IAHS. Primary dengue infection with serotype 1 or 3 and secondary infection with serotype 2 can lead to severe DHF [24].…”

“…Fourteen reports described favorable outcome after specific therapy with corticosteroids and/or IVIG with variable treatment regimes [1,3,4,7,9,[12][13][14][15][16][17][18][19]. There were a total of 61 patients, with 18 adults (range 16-46 years) and 43 pediatrics (range 50 days-15 years).…”

“…Severe dengue is a recognized cause for IAHS in Southeast Asia but overall worldwide incidence remains low between 2% and 35.7% [1][2][3][4][5][6][7][8][9].…”

Hemophagocytic Syndrome in Severe Dengue Fever: A Rare Presentation

“…Severe dengue can clinically manifest as shock, severe bleeding, and hepatic, cardiac or neurologic dysfunction [1]. It has being recognized as a cause of secondary HLH/HPS in Southeast Asia, but overall worldwide incidence of dengue associated hemophagocytosis remains low [3,[6][7][8].…”

“…Few cases have been reported in the English literature, and are mostly associated with severe dengue [6][7][8].…”