Dengue infection associated hemophagocytic syndrome: Therapeutic interventions and outcome

A Rare and Fatal Complication of a Self-Limiting Infection: A Case Report on Dengue Associated Hemophagocytic Lymphohistiocytosis

“…The aim of management for infection-induced HLH is to treat the underlying infection. There are a few documented literatures that reported cases that recovered spontaneously with just supportive treatment 5,6 . However, high dose of corticosteroids is often required to suppress the hyperinflammatory state.…”

Severe dengue due to secondary hemophagocytic lymphohistiocytosis: A case study

“…Dengue outbreaks occur in Eastern India every 3 to 4 years [7]. Given the fact that large numbers of people are affected by dengue every year, it is likely that number of dengue triggered HLH are also high and the spate of recent reports describing dengue induced HLH are testimony to this fact [8], [9], [10], [11], [12]. A mild disease in majority of cases, less than 2% of dengue patients present with severe manifestations, dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), both conditions are associated with considerable mortality and morbidity.…”

“…It is likely that the diagnosis of dengue induced HLH is missed as clinicians tend to focus on the underlying infection rather than the overwhelming cytokine production. HLH is a potentially life threatening disorder and several cases reports show dengue induced HLH can be fatal [11], [13], [14]. The pathophysiology of severe dengue (DHF, DSS) is not always well understood and it is now being increasingly believed that macrophage activation may play a role in some cases of severe dengue.…”

“…Most cases of HLH also need to be treated upfront with standard protocols. Regarding treatment of dengue associated HLH, review of the existing literature showed that few cases have recovered spontaneously with supportive treatment only [11], [15], [16]. However, in majority of the cases pulse dosage of methylprednisolone or dexamethasone have been used to suppress the hyperinflammatory state.…”

“…Raju et al reported successful use of intravenous immunoglobulin G in nineteen children suffering from dengue related HLH [16]. Srichaikul et al [13], Tan et al [9] and Wan et al [11] have reported treating three adult patients successfully with combination of intravenous immunoglobulin G and dexamethasone or methylprednisolone. In the present case high dose steroids was not considered because of associated pancreatitis and concurrent sepsis as the patient had high procalcitonin at presentation and evidence of chest infection in X ray.…”