Mizutani Naoya, Kenzaka Tsuneaki, Nishisaki Hogara
Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba 669-3495, Japan.
Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Chuo-ku, Kobe 650-0017, Japan.
Trop Med Infect Dis. 2023 Nov 15;8(11):497. doi: 10.3390/tropicalmed8110497.
Dengue fever (DF) can be complicated by hemophagocytic lymphohistiocytosis (HLH). Steroid administration is markedly effective for this hematologic complication, and for other viral infections. We present a rare case of DF-associated HLH that improved with steroid-sparing supportive care. A 47-year-old Japanese male with diabetes mellitus and no history of DF traveled to the Philippines 10 days before his hospitalization. Three days before emergency admission, he experienced fever and joint pain and was referred to our hospital for suspected DF, after blood tests indicated liver damage and thrombocytopenia. Erythema of the extremities and trunk appeared on day 2, and the next day neutrophils were 550 cells/μL, platelets 29,000 cells/μL, ferritin 9840 ng/mL, and fibrinogen 141 mg/dL. Bone marrow aspirate revealed hemophagocytic lymphohistiocytosis, and he was diagnosed with HLH. On day 4, the symptoms and findings improved; only supportive care without steroids was continued. He tested positive for dengue virus antigen on admission. He was discharged on day 9 of hospitalization in good general condition with no vascular leakage or bleeding and recovery of blood cells. Although steroid administration is markedly effective in cases of DF complicated by HLH, this case suggests that such cases can resolve with steroid-sparing supportive care.
登革热（DF）可并发噬血细胞性淋巴组织细胞增生症（HLH）。类固醇给药对这种血液学并发症以及其他病毒感染具有显著疗效。我们报告了1例罕见的与DF相关的HLH病例，该病例通过减用类固醇的支持性治疗得以改善。一名47岁的日本男性，患有糖尿病，无DF病史，在住院前10天前往菲律宾。在紧急入院前3天，他出现发热和关节疼痛，血液检查显示肝损伤和血小板减少，遂因疑似DF被转诊至我院。第2天出现四肢和躯干红斑，第3天中性粒细胞为550个/μL，血小板为29,000个/μL，铁蛋白为9840 ng/mL，纤维蛋白原为141 mg/dL。骨髓穿刺显示噬血细胞性淋巴组织细胞增生症，他被诊断为HLH。第4天，症状和检查结果有所改善；仅继续进行不使用类固醇的支持性治疗。入院时他的登革病毒抗原检测呈阳性。住院第9天，他状况良好出院，无血管渗漏或出血，血细胞恢复正常。尽管类固醇给药对并发HLH的DF病例具有显著疗效，但该病例表明，此类病例可通过减用类固醇的支持性治疗得到解决。
