Hemophagocytosis in dengue: comprehensive report of six cases.
Hemophagocytic syndrome is a potentially fatal disorder. It is being increasingly reported but remained under-recognized in dengue. Most reported cases were in association with plasma leakage and shock but multi-organ impairment was also observed. We describe the time-lines of 6 cases of confirmed dengue with varying severities of hemophagocytosis. All had persistent fever, cytopenia and elevated transaminases with markedly elevated ferritin levels during and beyond the plasma leakage phase. Acute renal failure and central nervous system manifestation were observed in two patients. Morphological hemophagocytosis was demonstrated in three patients. All survivors showed clinical and biochemical resolution of hemophagocytosis indicating its transient nature. Persistence of fever and cytopenia together with multi-organ dysfunction, out of proportion to and beyond the plasma leakage phase should prompt clinicians to consider this phenomenon.
Internal Medicine (Infectious Diseases) Consultant, Sunway Medical Centre, 5 Jalan Lagoon Selatan, Bandar Sunway, 46150 Petaling Jaya, Selangor, Malaysia. hutan07@gmail.com
Lian Huat
LH
Tan
Lucy Chai See
LC
Lum
Sharifah Faridah Syed
SF
Omar
Foong Kee
FK
Kan
D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D003715:Dengue / Q000097:blood / Q000473:pathology*; D005260:Female; D005293:Ferritins / Q000097:blood; D005334:Fever / Q000097:blood / Q000821:virology; D006801:Humans; D007970:Leukopenia / Q000097:blood / Q000821:virology; D051359:Lymphohistiocytosis, Hemophagocytic / Q000097:blood / Q000821:virology*; D008297:Male; D013921:Thrombocytopenia / Q000097:blood / Q000821:virology; D000637:Transaminases / Q000097:blood
D000914:Antibodies, Viral; D005293:Ferritins; D000637:Transaminases