Intravenous Immunoglobulin Responsive Persistent Thrombocytopenia after Dengue Haemorrhagic Fever

Abstract

Dengue outbreak is common in Indian subcontinent and causes significant morbidity and mortality. Year 2015 has witnessed yet another Dengue epidemic in northern India and the number of cases this year is maximum in a decade. Dengue infection is a viral disease and there are 4 different serotypes DENV1, DENV2, DENV3 and DENV4. This year DENV2 and DENV4 have been isolated from most of the patients. Thrombocytopenia is hallmark of dengue infection and generally recovers within ten days of onset of symptoms. We report a case of dengue haemorrhagic fever in which thrombocytopenia persisted for almost a month and improved after Intravenous immunoglobulin (IVIG) administration. This is the first case where IVIG has been successfully used for treating persisting thrombocytopenia after dengue infection.

Case of Near Fatal Massive Intracerebral Bleed Secondary to Cerebral Venous Thrombosis in a Patient with Dengue and Refractory Thrombocytopenia

“…14,15 There are reports in the literature showing success with IVIg for increasing the platelet count in DF. 16 Our patient however, remained refractory to these therapies. Lack of response to IVIg was similar to observation by Dimaano et al 17 Eltrombopag is a nonpeptide thrombopoietin receptor (TPO-R) agonist.…”

Missing Cells - A Rare Case of Persisting Thrombocytopenia in Pregnancy With Dengue and Role of Romiplostim in These Cases

“…Another case report with patients in the paediatric age group responded to steroids but developed chronic ITP ( 11 ). In another case report by Prabhat Kumar done in RML Delhi also did not respond to steroids and responded to IVIg ( 12 ). Romiplostim is used in only a few case reports and has shown promising results in dengue-induced thrombocytopenia ( 13 ).…”

Severe dengue in the intensive care unit

“…[ 154 ] Due to its rarity, only case reports can be found in the literature, and successful treatment has been published after the use of corticosteroids and IVIg. [ 151 , [155] , [156] , [157] ]…”