Prolonged fever and pancytopenia in a case of severe dengue may be secondary hemophagocytic lymphohistiocytosis

Dengue-Associated Hemophagocytic Lymphohistiocytosis: A Narrative Review of Its Identification and Treatment

“…Few patients had comorbid medical conditions; these included diabetes mellitus [ 44 , 45 , 46 ], hypertension [ 47 ], and obesity [ 48 ]. Patients were diagnosed using the criteria outlined by the HLH-2004 study [ 41 ], with 33 cases (84.6%) reporting hemophagocytosis on bone marrow aspirate (1 case was determined postmortem [ 49 ]), 1 case reported a false negative finding [ 50 ]), and no cases mentioned any procedural complications or difficulties.…”

“…Treatment of dengue-associated HLH was usually with short courses (about 3–4 days) of high-dose intravenous steroids, e.g., dexamethasone 10 mg/m 2 daily [ 51 ], with some patients tapering steroids over 2–8 weeks [ 40 , 50 , 52 , 53 , 54 , 55 ]. One case initiated and continued dexamethasone orally for a total of 26 days [ 56 ].…”

“…Fortunately, assessment of most of these criteria should be available in routine clinical practice. Some other clinical features can help distinguish severe dengue from dengue-associated HLH, as these are more commonly found in the latter: (1) prolonged or recurrent fever of >7 days [ 32 , 50 ] (consider also co-infection, which occurred in 10.4% of 122 cases [ 32 ]), and (2) anemia without intravascular hemolysis or massive bleeding [ 32 , 75 ].…”

“…The clinical management of dengue-associated HLH is summarized in Table 3 . When treatment is effective, gradual recovery with complete resolution of clinical and laboratory abnormalities within 2–8 weeks is expected [ 44 , 48 , 50 , 52 , 54 , 56 , 57 , 62 , 64 , 66 , 67 , 69 ].…”