Abstract
IntroductionCoinfection with dengue and hepatitis A is rare and challenging for physicians since their clinical features can be overlapping. These infections are self-limiting but can become complicated by subsequent infective endocarditis. We report a case of infective endocarditis following a coinfection with dengue and hepatitis A.Case presentationA 17-year-old Yemeni male patient was admitted to the hospital complaining of yellowish discoloration of the skin and sclera associated with dark urine and a diffuse skin rash on the trunk and upper limbs followed by intermittent high-grade fever. Coinfection was confirmed by hepatitis A immunoglobulin M and dengue immunoglobulin M. At the time of diagnosis, white blood cells were normal, with mild neutrophilia and thrombocytopenia along with elevated C-reactive protein. Five days later, the patient was readmitted to the emergency department, complaining of high-grade fever, fatigue, myalgia, nausea, and vomiting. A systolic heart murmur was heard, and infective endocarditis was confirmed by the visualization of two vegetations on the mitral valve and coagulase-negative staphylococci after blood culture. Supportive therapies were initiated for hepatitis A and dengue fever, whereas infective endocarditis was treated with antibiotics for 4 weeks. The patient recovered completely from dengue, hepatitis A, and infective endocarditis.ConclusionIn endemic areas, it is reasonable to screen for coinfection with dengue and hepatitis A since they are superimposed on each other. Subacute infective endocarditis may occur following initial dengue and hepatitis A coinfection, especially among patients with rheumatic heart disease. An echocardiogram is a pivotal workup for evaluating a patient with persistent fever of unknown origin.
Highlights
Coinfection with dengue and hepatitis A is rare and challenging for physicians since their clinical features can be overlapping
We report a case of an adult male who was initially diagnosed with dengue and hepatitis A coinfection but subsequently developed infective endocarditis by coagulase-negative staphylococci (CoNS)
During the first and second follow-up visits to the medical clinic, on day 3 and day 10 after discharge, the clinical features and laboratory investigations of the Discussion We report a case of infective endocarditis diagnosed a few days after the diagnosis and management of coinfection with dengue and hepatitis A in a 17-year-old Yemeni male patient
Summary
Coinfection with dengue and viral hepatitis can be encountered among young adults with rheumatic heart disease. A patient presenting with elevated liver enzymes, deranged coagulation profile, prolonged fever, pleural effusion, and thrombocytopenia should alert clinicians towards dengue and hepatitis A coinfection. Elevated aminotransferase levels (eight to ten times the upper limit) are consistent with acute viral hepatitis compared with two to three times in dengue fever, and the ratio of aspartate aminotransferase to lactate dehydrogenase is more than 4 in acute hepatitis. Elevated CRP and high pulse rate along with prolonged and high-grade fever in a patient with dengue should be considered as alarming signs for concurrent bacterial infection. Echocardiography and blood culturing are pivotal workups in patients with persistent fever of unknown origin. Timely administration of optimal antibiotics is critical for patients with mixed infections to avoid life-threatening complications. The second important limitation is that blood samples for cultures were collected after the administration of empirical antibiotics.
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