Dengue Fever in Liver Transplant Recipients

Abstract

Dengue fever is a common mosquito borne disease in India. Dengue fever in liver transplant recipient has rarely been described. We report 2 cases of dengue fever in our liver transplant patients. Case presentation: Case 1- A 37 yr old male patient, underwent deceased donor liver transplantation on 26.05.2015, presented 3 months later with history of fever, myalgia, arthralgia, thrombocytopenia, leukopenia. His low platelet and WBC counts were initially attributed to hypersplenism. Dengue was diagnosed using NS1 antigen test and he was managed conservatively as for dengue fever. He recovered well and his graft is functioning well till last follow up. Case 2- A 26 yr old male patient, underwent deceased donor liver transplantation in October 2019, presented 2 years later with history of fever, thrombocytopenia, elevated liver enzymes. He had history of biliary stenting for post operative anastomotic stricture. Initially, stent block cholangitis was suspected. Dengue IgM antibody test was negative but NS1 antigen test was positive. Final diagnosis of dengue fever was made. He improved with conservative management. He is doing well till last follow up. Conclusion: Reports of dengue fever in liver transplant recipients are limited. The presentation may be atypical. It should be suspected when patient present with fever with thrombocytopenia, along with other possible causes. NS1 antigen has better sensitivity than IgM Elisa. Both should be included in diagnostic work up. Dengue fever usually follows a mild course in primary infection and most patients recover well. Dengue fever does not affect graft function in long term.