Severe Dengue Fever with Haemolytic Anaemia-A Case Study.

Mra Aye,Jason Cabot,Lee William

doi:10.3390/tropicalmed1010006

Abstract

Dengue fever, the most common arthropod-borne viral infection in South East Asia, is increasing in prevalence due partially to increased awareness and better diagnostic methods. While haematologic complications, such as cytopeniae and bleeding, may occur in severe dengue infection due to a variety of aetiologies, reports of haemolytic anaemia in dengue fever are scant. We report a case of severe dengue fever with haemolytic anaemia following the critical phase of infection.

Highlights

A 22-year-old male was admitted with a three-day history of high-grade continuous fever with chills, vomiting and loose stools
Clinically detectable haemolysis occurred on day 6 of admission in our patient, higher indirect than direct bilirubin was noted since the first day of admission, together with high AST and LDH (Table 1), suggesting asymptomatic haemolysis was present since admission
We present a case of dengue fever with a short duration of a brisk haemolytic anaemia with a positive indirect Coombs’ test, manifesting in the second week of illness after recovery from the critical period

Summary

Case History

A 22-year-old male was admitted with a three-day history of high-grade continuous fever with chills, vomiting and loose stools He denied abdominal pain, myalgia, retro-orbital pain, back pain or other systemic symptoms. On day three post-admission he developed tachycardia, mild abdominal pain and tenderness, and falling blood pressure. He was seen to have compensated metabolic acidosis and prolonged activated partial thromboplastin time (APTT) (Table 2). The fluid therapy was continued in the same dose or decreased to 1–2 mL/Kg/h to blood pressure, clinical status, and haematocrit until day 3 post-admission. Anti-dengue IgM and IgG antibodies in blood drawn two weeks after discharge subsequently were positive (Table 2)

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Conclusions