Hemophagocytic lymphohistiocytosis: a rare and fatal manifestation of dengue fever

Karan Singla; Ajay Singh; Sameer Sethi; Priyankar K. Datta

doi:10.18203/2320-6012.ijrms20200553

Authors

Karan Singla Department of Anaesthesiology and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Ajay Singh Department of Anaesthesiology and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Sameer Sethi Department of Anaesthesiology and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Priyankar K. Datta Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20200553

Keywords:

Dengue, Hemophagocytic lymphohistiocytosis, HLH, Pancytopenia

Abstract

Authors describe a rare case of dengue fever manifesting as hemophagocytic lymphohistiocytosis. A 26-year-old man presented with acute gastroenteritis along with high grade fever, leukopenia, thrombocytopenia, acute kidney injury, liver dysfunction. Further work-up revealed elevated serum ferritin and LDH levels, and bone marrow biopsy showed hemophagocytes. As dengue fever is in rising trend all over the world, especially in Asian countries, clinicians should look out for this rare but potentially fatal complication of dengue fever.

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References

Simmons CP, Farrar JJ, Nguyen VC, Wills B. Dengue. N Engl J Med. 2012;366:1423-32.

Ramos-Casals M, Brito-Zerón P, López-Guillermo A, Khamashta MA, Bosch X. Adult haemophagocytic syndrome. Lancet. 2014 Apr 26;383(9927):1503-16.

Fisman DN. Hemophagocytic syndromes and infection. Emerg Infe Dis. 2000 Nov;6(6):601.

Lei HY. Transient hemophagocytic activity in dengue immunopathogenesis. J Form Med Assoc. 2009 Aug 1;108(8):595-8.

Nelson ER, Bierman HR, Chulajata R. Hematologic Phagocytosis in Postmortem Bone Marrows of Dengue Hemorrhagic Fever. (Hematologic Phagocytosis in Thai Hemorrhagic Fever.)(Pediatric Dengue.). Am J Med Sci. 1966;252(1):68-74.

Filipovich AH. Hemophagocytic lymphohistiocytosis (HLH) and related disorders. ASH Edu Prog Book. 2009;2009(1):127-31.

Tan LH, Lum LC, Omar SF, Kan FK. Hemophagocytosis in dengue: comprehensive report of six cases. J Clin Virol. 2012 Sep 1;55(1):79-82.

Arico M, Janka G, Fischer A, Henter JI, Blanche S, Elinder G, et al. Hemophagocytic lymphohistiocytosis. Report of 122 children from the International Registry. FHL Study Group of the Histiocyte Society. Leukemia. 1996 Feb;10(2):197-203.

Jordan MB, Allen CE, Weitzman S, Filipovich AH, McClain KL. How I treat hemophagocytic lymphohistiocytosis. Blood, J Am Soci Hematol. 2011 Oct 13;118(15):4041-52.

Robert A. Raschke and Roxanne Garcia-Orr. Hemophagocytic Lymphohistiocytosis A Potentially Underrecognized Association with Systemic Inflammatory Response Syndrome, Severe Sepsis, and Septic Shock in Adults. Chest. 2011;140:933-8.