Title: Early Presentation of Hemophagocytic Lymphohistiocytosis Secondary to Severe Dengue: A Case Report
Authors: Arun Kumar N, Senthil Kumar SP, Manish Sharma
DOI: https://dx.doi.org/10.18535/jmscr/v8i5.71
Abstract
Background: In recent years increased number of atypical manifestations of dengue fever in children has been reported. Many infections can trigger hemophagocytosis and is often misinterpreted as sepsis with multi-organ dysfunction (MODS). Dengue virus is recognized as a trigger for infection associated hemophagocytosis.
Case Report: A 2 year 11 months old male child presented with history of fever and decreased oral intake since 2 days. Child had signs of severe shock, hepatospleenomegaly with decreased air entry in bilateral lower lung fields on systemic examination. Blood investigations showed thrombocytopenia, leucopenia, negative crp, severely deranged coagulation profile, elevated liver enzymes, dengue NS1 and IgM ELISA positive and high ferritin levels. In view of the above presentation, possibility of secondary hemophagocytic lymphohistiocytosis (HLH) due to dengue infection was considered. Bone marrow aspiration showed histiocytosis with hemophagocytosis. Child met the diagnostic criteria of HLH (2004) and was started on injection dexamethasone according to HLH protocol. Child clinically improved and was discharged on oral dexamethasone.
Conclusion: We would like to emphasise that high level of suspicion is required in diagnosing secondary HLH and it should be considered in the early part of dengue infection if child presents with cytopenias, hyperferritinemia, splenomegaly and MODS.
Keywords: Dengue, Hemophagocytic Lymphohistiocytosis, High Ferritin.
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