Tasmina Chowdhury¹, Imran Sikder², Sabira Haque Biva³ and Quazi Tarikul Islam⁴*

¹Assistant Professor of Medicine, Popular Medical College and Hospital, Dhaka, Bangladesh
²Assistant, Registrar of Medicine, Popular Medical College and Hospital, Dhaka, Bangladesh
³Intern Doctor, Popular Medical College and Hospital, Dhaka, Bangladesh
⁴Professor of Medicine, Popular Medical College Hospital, Dhaka, Bangladesh

*Corresponding Author: Quazi Tarikul Islam, Professor of Medicine, Popular Medical College Hospital, Dhaka, Bangladesh.

Received: April 12, 2023; Published: April 21, 2023

Abstract

Dengue fever is still evolving to clinicians with changing and more challenging clinical and biochemical pattern even after more than two decades of epidemic. Most of cases being secondary infection showing increasing tendency to develop unusual and more severe form of disease. This case report is on a middle aged man who developed severe dengue in the form of Expanded Dengue Syndrome (EDS). Despite having severe Dengue hypovolemia was not a prominent feature. Along with broad spectrum of organ involvement he developed some very unusual features like Pneumonia, Hemophagocytic Lymphohistiocytosis (HLH), and most strikingly Haemolytic anaemia. Though Coombs test became negative, hemolysis was unexplainable other than autoimmune process. He was managed with broad spectrum antibiotics, methylprednisolone, transfusion of apheretic platelet, FFP and packed red blood cell. Prompt recognition and management saved the life of the patient.

Keywords: Expanded Dengue Syndrome (EDS); Hemophagocytic Lymphohistiocytosis (HLH); Haemolytic Anaemia

Bibliography

1. World Health Organization. Disease Outbreak News; Dengue - Bangladesh (2022).
2. Global strategy for dengue prevention and control 2012-2020. World Health Organization; (2012).
3. Anam AM., et al. “Expanded Dengue Syndrome: Gastrointestinal Manifestation”. Bangladesh Critical Care Journal (2019): 34-39.
4. Tansir G., et al. “Expanded dengue syndrome in secondary dengue infection: A case of biopsy proven rhabdomyolysis induced acute kidney injury with intracranial and intraorbital bleeds”. Intractable and Rare Diseases Research4 (2017): 314-318.
5. Woon YL., et al. “A Two-Year Review on Epidemiology and Clinical Characteristics of Dengue Deaths in Malaysia, 2013-2014”. PLOS Neglected Tropical Diseases5 (2016): e0004575.
6. Islam QT., et al. “Changing Clinical Pattern of Dengue Fever and Its Unusual Manifestations- 9 2019 Outbreak in Dhaka, Bangladesh”. Journal of Bangladesh College of Physicians and Surgeons1 (2020): 9-18.
7. Umakanth M and Suganthan N. “Unusual manifestations of dengue fever: a review on expanded dengue syndrome”. Cureus 12 (2020): e10678.
8. “Expanded dengue syndrome in secondary dengue infection: a case of biopsy proven rhabdomyolysis induced acute kidney injury with intracranial and intraorbital bleeds”. Intractable and Rare Diseases Research 6 (2017): 314-318.
9. Simmons CP., et al. “Dengue”. The New England Journal of Medicine 15 (2012): 1423-1432.
10. Marchiori E., et al. “Dengue hemorrhagic fever another cause of diffuse alveolar hemorrhage in immunocompetent patients”. Respiratory Medicine12 (2012): 1807-1808.
11. Nagassar RP., et al. “Staphylococcus aureus pneumonia and dengue virus co-infection and review of implications of coinfection”. BMJ Case Report (2012): pii: bcr0220125804.
12. Schmid MA., et al. “Influenza and dengue virus co-infection impairs monocyte recruitment to the lung, increases dengue virus titers, and exacerbates pneumonia”. European Journal of Immunology3 (2017): 527-539.
13. Afsar N., et al. “Anemia: A Diagnostic Malady in Management of Dengue Patients”. Annals of Pathology and Laboratory Medicine12 (2019): A647-652.
14. Medagoda K and Silva H de. “A case of selflimiting Coomb’s negative haemolytic anaemia following dengue shock syndrome”. Ceylon Medical Journal4 (2011): 147-148.
15. Bardill B., et al. “The diagnosis and management of primary autoimmune haemolytic anaemia. Br. J. Haematol. 176 (2017): 395-411. doi: 10.1111/bjh.14478
16. Bardill B., et al. “Severe IgA-mediated auto-immune haemolytic anaemia in a 48-yr-old woman”. European Journal of Haematology1 (2003): 60-63.
17. Stone MJ. “Heating up cold agglutinins”. Blood17 (2010): 3119-3120.
18. Special Programme for Research and Training in Tropical Diseases, World Health Organization, editors. Dengue: guidelines for diagnosis, treatment, prevention, and control. New ed. Geneva: TDR: World Health Organization (2009): 147.
19. Afsar N., et al. “Anemia: A Diagnostic Malady in Management of Dengue Patients”. Annals of Pathology and Laboratory Medicine12 (2019): A647-652.
20. Oliveira JF and Burdmann EA. “Dengue-associated acute kidney injury”. Clinical Kidney Journal 6 (2015): 681-685.
21. Brisse E., et al. “How Viruses Contribute to the Pathogenesis of Hemophagocytic Lymphohistiocytosis”. Frontiers in Immunology 8 (2017): 1102.
22. Henter JI., et al. “HLH‐2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis”. Pediatric Blood Cancer2 (2007): 124‐131.

Citation: Quazi Tarikul Islam., et al. “A Fatal Clinical Case of Expanded Dengue Syndrome; Fortunately Saved". Acta Scientific Clinical Case Reports 4.5 (2023): 11-17.

Copyright: © 2023 Quazi Tarikul Islam., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.