Dengue haemorrhagic fever complicated with intravascular haemolysis, coagulopathy and haemophagocytic lymphohistiocytosis: a case report
Abstract
Background: Dengue haemorrhagic fever (DHF) may occasionally manifest with atypical or severe complications under the umbrella of expanded dengue syndrome (EDS). Haemophagocytic lymphohistiocytosis (HLH) and intravascular haemolysis are rare but potentially fatal complications that require a high index of suspicion, particularly when clinical deterioration persists beyond the critical phase.
Case presentation: We report a previously healthy 19-year-old woman who presented with DHF and subsequently developed persistent fever, worsening transaminitis, rising bilirubin levels, haemoglobinuria, and progressive cytopaenia despite completion of the critical phase. Laboratory evaluation demonstrated markedly elevated ferritin (> 40,000 ng/mL), hypertriglyceridaemia, hypofibrinogenaemia, and features of intravascular haemolysis, including indirect hyperbilirubinaemia, reticulocytosis, elevated LDH and a negative direct antiglobulin test. Ultrasonography revealed new splenomegaly. Bone marrow aspirate confirmed haemophagocytosis. She met six HLH-2004 diagnostic criteria, supporting a diagnosis of secondary HLH triggered by acute dengue infection. The patient was treated with intravenous dexamethasone (10 mg/m²/day) for 14 days with tapering, alongside transfusion support, N-acetylcysteine, and cautious fluid management. She achieved full clinical and biochemical recovery.
Conclusion: This case highlights a rare but severe manifestation of EDS where DHF was complicated by…
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- The Matrisome: In Silico Definition and In Vivo Characterization by Proteomics of Normal and Tumor Extracellular Matrices
- The Escherichia coli MG1655 in silico metabolic genotype: Its definition, characteristics, and capabilities
- In silico pharmacology for drug discovery: methods for virtual ligand screening and profiling
- In silico prediction of splice-altering single nucleotide variants in the human genome
- In silico clinical trials: how computer simulation will transform the biomedical industry
- In silico optimization of a guava antimicrobial peptide enables combinatorial exploration for peptide design
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.