Severe dengue due to secondary hemophagocytic lymphohistiocytosis: A case study

Ray, Ujjwayini; Dutta, Soma; Mondal, Susovan; Bandyopadhyay, Syamasis

doi:10.1016/j.idcr.2017.03.013

Cited by 28 publications

(22 citation statements)

References 14 publications

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“…Then, among the multiple implications, multiple factors suggest the risk that both may lead to severe disease simultaneously. Both viral diseases may trigger secondary hemophagocytic lymphohistiocytosis [ [26] , [27] , [28] ], leading patients to present hypovolemic shock, vasoplegia, and cardiopulmonary collapse due to hyperinflammation and hyperactivation of the immune system. However, this was not explicitly observed in this cohort from Peru [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of patients coinfected with Severe Acute Respiratory Syndrome Coronavirus 2 and dengue virus, Lambayeque, Peru, May–August 2020: A retrospective analysis

Mejía-Parra

Aguilar-Martínez

Fernández-Mogollón³

et al. 2021

Travel Medicine and Infectious Disease

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Introduction Before the Coronavirus Disease 2019 (COVID-19) arrival and its pandemic, dengue was already a significant cause of epidemics in South East Asia and Latin America. In 2020 with their cocirculation, coinfections began to be observed and reported in different countries. As expected, this syndemic is evident in different areas and deserves proper characterisation and studies in Peru. Methods We retrospectively assessed the clinical, epidemiological, diagnostic characteristics and outcomes in a Social Security Hospital of Chiclayo, Lambayeque, Peru, of patients that were diagnosed simultaneously with COVID-19 and dengue during May–August 2020. Results A total of 50 patients with COVID-19/dengue coinfection were identified. Of them, 60% presented thrombocytopenia, and 52% fever, among other findings. The case fatality rate in this group was 28%, being higher in those patients initially classified as severe dengue (100%), as well as in females (55%) than males (21%) (OR = 4.65; 95%CI 1.18–18.45). Discussion Co-occurrence of COVID-19/Dengue is growing as a consequence of the syndemic of these viral diseases in endemic areas, such as Latin America, and as both conditions may evolve to severe disease, their epidemiological but clinical interaction in terms of outcomes need further assessment in future studies in the region.

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Section: Discussionmentioning

confidence: 99%

Characteristics of patients coinfected with Severe Acute Respiratory Syndrome Coronavirus 2 and dengue virus, Lambayeque, Peru, May–August 2020: A retrospective analysis

Mejía-Parra

Aguilar-Martínez

Fernández-Mogollón³

et al. 2021

Travel Medicine and Infectious Disease

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“…Hemophagocytic lymphohistiocytosis is a rare hyper inflammatory disorder related to macrophage activation and usually presents as prolonged fever and sepsis-like syndrome [1] . Two types of HLH are seen that include primary (familial) form which is a fatal autosomal recessive disorder, whereas the secondary or reactive form is associated with viral, bacterial, fungal, or parasitic infections as well as with connective tissue disorders and malignancy [2] .…”

Section: Discussionmentioning

confidence: 99%

Case report: Primary hemophagocytic syndrome triggered by dengue infection

Devi

Ali

2021

IDCases

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HLH is a progressive syndrome of unchecked immune activation and tissue damage. If left untreated, patients with HLH survive for only a few months, due to progressive multi-organ failure. Prompt initiation of treatment for HLH is essential for the survival of affected patients. Several conditions are responsible for triggering HLH in clinically stable patients who respond to treatment of the underlying condition alone. These conditions include infection, rheumatological diseases and lymphoid malignancies. We report a rare case of primary HLH in a 32-year-old female who presented with fever, abdominal pain, pancytopenia and splenomegaly with the triggering factor being Dengue infection.

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“…There are several reported cases of HLH as a secondary manifestation of dengue infection both in the paediatric and adult population. Most of these cases have occurred in patients without any other comorbidities; however, one case has reported co-infection with Plasmodium vivax, and another case has occurred in a young child with beta-thalassemia major [3,9,[19][20][21][22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Hemophagocytic Lymphohistiocytosis; A Rare Complication Of Dengue Haemorrhagic Fever

Pradeep¹,

Karunathilake

Abeygunawardena

et al. 2021

Preprint

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Background Haemophagocytic Lymphohistiocytosis (HLH) is an uncommon systemic inflammatory clinical syndrome associated with numerous conditions and a rare complication of dengue associated with significant mortality and morbidity even with appropriate treatment. The outcome is further poor if the diagnosis is delayed or left untreated. Therefore a high degree of clinical suspicion is paramount in the diagnosis of HLH, especially in an atypical presentation of dengue infection. Case Presentation A 17-year-old boy with a non-significant past medical history admitted with a four-day history of fever, headache, nausea, vomiting, and loose stool. On admission, he was hemodynamically stable and managed as serologically confirmed dengue fever. On the 5th day of fever, he entered the critical phase, which was uncomplicated except for high fever spicks. Even after the critical phase was over, he had ongoing high fever spicks, hepatosplenomegaly with persistent thrombocytopenia, neutropenia and anaemia. Serum ferritin level was > 3000 ng/ml, while the triglyceride level was 314 mg/dl. Bone marrow biopsy revealed an increased haemophagocytic activity. Secondary HLH was diagnosed based on criteria used in the HLH-2004 trial and successfully managed with intravenous dexamethasone 10 mg/body surface area/day for the first two weeks followed by tapering of course over eight weeks. Conclusion Though this is a rare complication, the clinician must suspect HLH in expanded dengue syndrome complicated with ongoing fever, splenomegaly with cytopenias, and necessary investigations to establish a firm diagnosis. Early treatments will result in promising outcomes while preventing complications and reducing mortality.

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Severe dengue due to secondary hemophagocytic lymphohistiocytosis: A case study

Cited by 28 publications

References 14 publications

Characteristics of patients coinfected with Severe Acute Respiratory Syndrome Coronavirus 2 and dengue virus, Lambayeque, Peru, May–August 2020: A retrospective analysis

Characteristics of patients coinfected with Severe Acute Respiratory Syndrome Coronavirus 2 and dengue virus, Lambayeque, Peru, May–August 2020: A retrospective analysis

Case report: Primary hemophagocytic syndrome triggered by dengue infection

Hemophagocytic Lymphohistiocytosis; A Rare Complication Of Dengue Haemorrhagic Fever

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