Systematic review of spontaneous splenic rupture in dengue‐infected patients

Abstract

Summary Dengue infection varies from a mild febrile form to more severe disease with plasma leakage, shock, and multiorgan failure. Several serious complications such as cardiomyopathy, encephalopathy, encephalitis, hepatic damage, and neural manifestations cause organ damage in dengue infection. Splenic rupture, a less well known but life‐threatening complication, can occur in dengue. The mechanism of splenic rupture in dengue is still unclear. Optimal therapeutic management is required to save the lives of patients with this complication. The objective of this study was to conduct a systematic review of studies documenting the development of spontaneous nontraumatic splenic rupture in patients with dengue infection. In March 2018, a search was conducted systematically in nine electronic databases, in addition to hand‐ searching. A total of 127 references were exported to Endnote; 47 references remained after removing duplicates. Finally, 16 reports met the inclusion criteria and represented 17 cases. All articles were evaluated and data extracted according to predefined criteria: number of cases, age, sex, severity of dengue disease, days of illness before admission, methods of definitive diagnosis, timing of the event, and management and outcome. A total of 17 individual patients including 13 males and four females were found. Most of the patients were young adults (ranging from 20 to 52 years) and diagnosed with computed tomography scan and managed with splenectomy. Four cases were fatal. Pathological splenic rupture in dengue is a rare, life‐threatening condition where timely management can achieve a favorable outcome.

A rare case of malignant hypertension with splenic rupture and thrombotic microangiopathy

“…[ 14 ] It has varied pathogenesis and etiologies, such as infectious diseases, splenic occupying diseases, hematological diseases, drug-induced events, and splenic artery aneurysm. [ 14 – 16 ] Our case was the first with pathologically-proven splenic TMA induced by MHT and based on the direct pathological characteristics of the spleen, such as hyaline degeneration in the small artery wall, focal fibrous necrosis, thrombosis, and partial small vessel occlusion. In theory, MHT could damage the micro-endothelial cells of viscera such as spleen by elevated shear stress, inflammation, over-activation of complement, aberrant coagulation “storm” and so on, besides the more often targeted organs like kidney, brain and heart.…”

Unexpected death involving the spleen – an overview

“…Other viral infections that are associated with splenic rupture include dengue virus, cytomegalovirus, human immunodeficiency virus 24 and COVID-19. 25,26…”

“…Male patients under the age of 30 years were found to be the most susceptible, with an overall mortality rate of 9%, with all fatal cases occurring within 10 days of symptom onset. 23 Other viral infections that are associated with splenic rupture include dengue virus, cytomegalovirus, human immunodeficiency virus 24 and COVID-19. 25,26 If a previous splenectomy has been performed following trauma or due to haematological diseases, 2 immunisations and prophylactic antibiotics are required because of the increased risk of infection due to bacteria such as Streptococcus pneumoniae or Haemophilus influenza.…”

A Case of Dengue Fever with Diet Management

“…Dengue virus can lead to grave complications such as dengue hemorrhage fever and dengue shock syndrome. Certain serious complications such as myocarditis, encephalopathy, liver failure, splenic rupture, acute kidney injury, pancreatitis and muscle hematoma also associated with dengue fever [1][2][3][4][5][6].…”