Ray Ujjwayini, Dutta Soma, Mondal Susovan, Bandyopadhyay Syamasis
Apollo Gleneagles Hospitals, 58, Canal Circular Road, Kolkata 70054, West Bengal, India.
IDCases. 2017 Mar 30;8:50-53. doi: 10.1016/j.idcr.2017.03.013. eCollection 2017.
Dengue, transmitted by the mosquito affects millions of people worldwide every year. Dengue induced hemophagocytic lymphohistiocytosis (HLH) is a serious condition and may prove fatal if not detected early and treated appropriately. Diagnosis of HLH is challenging and usually missed as clinical and laboratory findings are nonspecific. Moreover, the pathophysiology of the systemic inflammatory response syndrome and/or sepsis is remarkably similar to HLH. Secondary HLH following infection by the dengue virus is now being increasingly recognized as a cause of severe form of the disease. We report a case of dengue associated HLH in an otherwise healthy person who deteriorated during the course of hospitalization. A disproportionately high ferritin level and persistent bicytopenia prompted investigations for HLH. Diagnosis of dengue fever with virus-associated hemophagocytic syndrome was established according to the diagnostic criteria laid down by the Histiocyte Society. We discuss the diagnosis and management of this complex case and try to generate awareness about dengue induced HLH as one of the possible causes for severe manifestations of this infection.
登革热通过蚊子传播，每年影响全球数百万人。登革热诱发的噬血细胞性淋巴组织细胞增生症（HLH）是一种严重疾病，如果不及早发现并进行适当治疗，可能会致命。HLH的诊断具有挑战性，通常会被漏诊，因为临床和实验室检查结果不具有特异性。此外，全身炎症反应综合征和/或败血症的病理生理学与HLH非常相似。登革热病毒感染后的继发性HLH现在越来越被认为是该疾病严重形式的一个病因。我们报告一例原本健康的人在住院期间病情恶化的登革热相关HLH病例。铁蛋白水平异常升高和持续性双血细胞减少促使对HLH进行调查。根据组织细胞协会制定的诊断标准，确诊为登革热伴病毒相关噬血细胞综合征。我们讨论了这个复杂病例的诊断和管理，并试图提高人们对登革热诱发HLH作为这种感染严重表现的可能原因之一的认识。
