Severe Thrombotic Events Associated with Dengue Fever, Brazil

Abstract

Abstract. Dengue fever has been a major problem in hospital settings in Brazil for the past 15 years. The main concern has been the severe forms, i.e., dengue hemorrhagic fever and dengue shock syndrome. Hemorrhagic events of different degrees have also been a major concern. We report five cases of large vein thrombotic events associated with the acute phase of dengue fever, including a previously non-reported case of mesenteric vein thrombosis. Complications such as these could have been overlooked in the diagnosis of dengue fever, given that the major concern is the hemorrhagic event.Dengue fever frequently affects Brazil, where thousands of cases have been diagnosed annually and all four dengue virus serotypes (DENV-1 through DENV-4) have been reported, sometimes concurrently in the same region.

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

“…da Costa et al reported five cases with nonneurological thrombotic complications in patients with dengue fever (DF). 1 We were able to find two case reports of CVT in dengue in literature. 2,3 In both these reports, patients improved subsequently with adequate fluids and anticoagulation, with none of them requiring surgical intervention.…”

A Case of Dengue Fever Complicated with Trombophlebitis in a Child

“…Dengue fever cases frequently present with hemorrhagic complications, although rare, complications such as deep vein thrombosis or arterial thrombosis may occur in these patients (4). In Dengue fever, thrombotic complications may be due to hemoconcentration secondary to dehydration in the early period and may also be observed in later stages due to changes in the levels of coagulation factors.…”

“…As a result of severe dehydration in these patients; due to increased vascular permeability and fever, hemoconcentration is common. In addition to these factors, protein C and S depletion and decreased plasma activity in the course of Dengue fever have also been reported (4). The combination of all these factors results in thrombosis and risk of secondary thrombophlebitis in patients with Dengue's fever.…”

Central retinal vein occlusion concomitant with dengue fever

“…Severe dehydration, a well known condition associated with thrombotic events, was not detected in any of these patients. Likewise, thrombotic events in these patients were thought to be due to loss of endothelial non-thrombogenic protective factors early in the course of the disease [10]. …”