Pulmonary Hemorrhage Syndrome Associated with an Autochthonous Case of Dengue Hemorrhagic Fever

Abstract

Dengue fever is a major public health problem worldwide. Dengue hemorrhagic fever, a much rarer form of the disease, occurs when a person previously infected with dengue is re-infected with a different viral serotype. In recent years the infection rates of dengue and both clinical syndromes have increased along the United States-Mexico border. We present the case of a 61-year-old Laotian female who presented with a 1-week history of fever, altered mental status, oral ulceration, and rash. The patient developed diffuse pulmonary hemorrhage and anemia requiring multiple transfusions. She eventually sustained multi-organ system failure and expired. Both the titer data and serologies were consistent with the diagnosis of dengue hemorrhagic fever. We hypothesize that this syndrome was the result of re-infection occurring within the United States. This case is also unusual in that it is the second reported in the literature of pulmonary hemorrhages associated with dengue hemorrhagic fever.

The Pathology of Severe Dengue in Multiple Organs of Human Fatal Cases: Histopathology, Ultrastructure and Virus Replication

“…In fact, clinical and necropsy data, as well as our histopathological analysis, indicated that all patients died from acute pulmonary edema. Pulmonary complications during dengue infection are scarcely described, characterized mainly by hemoptysis, pulmonary hemorrhage and congestion of alveolar septa, which may lead to the rupture of alveolar walls [8], [17], [24], [65]. In the present work, we observed the highest percentage of areas with hemorrhage and edema, comparing to other organs, and several mononuclear infiltrates as well as hyperplasia of alveolar macrophages in all the four dengue cases.…”

“…Furthermore, we noted that cases 1 and 2, who also had co-morbidities (diabetes and obesity, respectively), showed strong septum thickening associated with increase of cellularity. Damages in the lung tissue from these two cases indicated that they had suffered a dengue shock syndrome, which leaded to hyaline membrane formation as described elsewhere [17], [24]. The presence of hyaline membrane is also found in the lung of patients with shock in Acute Respiratory Distress Syndrome (ARDS), but its pathogenesis seems to be different from dengue, since ARDS lead mainly to neutrophil inflammation [66], [67], whereas in dengue cases we observed only mononuclear infiltrates.…”

“…Additionally, other studies showed several lesions in spleen tissues, such as interstitial edema, vascular congestion, splenic rupture and bleeding [17], [18], [23]. However, recently, atypical clinical manifestations of dengue have been reported, involving the kidney, lung, heart and central nervous system, which were also corroborated by histopathological findings revealing several areas with hemorrhage, edema and inflammatory infiltrates in these organs [24]–[28].…”

Dengue virus regulates the expression of hemostasis-related molecules in human vein endothelial cells

“…The primary signs of DHF and DSS, including hemorrhage, increase in vascular permeability and hypovolemic shock, suggest defects in hemostasis, which may be involved in the pathogenesis of the disease. 1,2 Vascular endothelial cells (VECs) play important roles in regulation of vascular permeability and maintenance of a normal blood dynamics. It has been known that DV is able to infect VECs.…”

Unprovoked hemothorax : an unusual presentation in Dengue Haemorrhagic Fever

“…3,4 The infection of human haematopoietic cells causes alterations in megakaryocytopoieses, leading to thrombocytopenia. Haemorrhage can occur as a result of thrombocytopenia or DIC.…”