Davis Dominique D, Guleryuz Saffett, Galili Yehuda, Bejarano Pablo A
Department of Pharmacy, Department of Hematology and Oncology, Cleveland Clinic Florida, Weston, Florida, USA.
Department of Hematology and Oncology, Cleveland Clinic Florida, Weston, Florida, USA.
Case Rep Infect Dis. 2025 Jul 30;2025:9208878. doi: 10.1155/crdi/9208878. eCollection 2025.
Hemophagocytic lymphohistiocytosis is a fatal hyperinflammatory disorder in which CD8+ cytotoxic T-cells, natural killer cells, and macrophages destroy hematopoietic cells and vital organs. Viral infections, such as Epstein-Barr virus, are known to cause secondary hemophagocytic lymphohistiocytosis in adult patients. However, despite its rarity, dengue virus has been identified to potentially cause hemophagocytic syndrome, which is associated with significant mortality and morbidity. Herein, we present a case report of a 52-year-old male patient who presented with fevers, worsening non-bloody copious diarrhea, excessive fatigue, and nausea and vomiting. He was known to have sickle cell trait. A diagnosis of hemophagocytic lymphohistiocytosis was confirmed with a liver biopsy, accompanied by elevated ferritin levels (33,539 ng/mL), IL-2R levels (5944.2 pg/mL), thrombocytopenia (49 k/μL), anemia (hemoglobin and mean corpuscular volume of 7.3 g/dL and 77.3 fL), and elevated bilirubin (total bilirubin of 3.2 mg/dL). In addition, elevated IgG and IgM antibodies determined reinfection with dengue virus. The administration of dexamethasone, etoposide, and additional supportive medications was initiated. Despite all efforts, the patient's neurological status declined, and the patient died. In this case, dengue-induced hemophagocytic lymphohistiocytosis is a worrisome and challenging diagnostic condition, primarily due to the similarities between the symptoms of hemophagocytic lymphohistiocytosis and those of dengue hemorrhagic fever. Treatment delay may be an inevitable consequence. Differentiating between dengue hemorrhagic fever and dengue-induced hemophagocytic lymphohistiocytosis requires evaluating clinical, laboratory, and biopsy findings. The role of the sickle cell trait is unknown in the presentation.
噬血细胞性淋巴组织细胞增生症是一种致命的高炎症性疾病，其中CD8 + 细胞毒性T细胞、自然杀伤细胞和巨噬细胞会破坏造血细胞和重要器官。已知病毒感染，如爱泼斯坦 - 巴尔病毒，会在成年患者中引起继发性噬血细胞性淋巴组织细胞增生症。然而，尽管登革热病毒罕见，但已被确定有可能导致噬血细胞综合征，这与显著的死亡率和发病率相关。在此，我们报告一例52岁男性患者的病例，该患者出现发热、非血性大量腹泻加重、极度疲劳以及恶心和呕吐。已知他有镰状细胞性状。通过肝活检确诊为噬血细胞性淋巴组织细胞增生症，同时伴有铁蛋白水平升高（33,539 ng/mL）、IL - 2R水平升高（5944.2 pg/mL）、血小板减少（49 k/μL）、贫血（血红蛋白和平均红细胞体积分别为7.3 g/dL和77.3 fL）以及胆红素升高（总胆红素为3.2 mg/dL）。此外，IgG和IgM抗体升高确定为登革热病毒再次感染。开始给予地塞米松、依托泊苷和其他支持性药物治疗。尽管全力救治，患者的神经状态仍恶化，最终死亡。在这种情况下，登革热诱发的噬血细胞性淋巴组织细胞增生症是一种令人担忧且具有挑战性的诊断情况，主要是由于噬血细胞性淋巴组织细胞增生症的症状与登革出血热的症状相似。治疗延迟可能是不可避免的后果。区分登革出血热和登革热诱发的噬血细胞性淋巴组织细胞增生症需要评估临床、实验室和活检结果。镰状细胞性状在该病例中的作用尚不清楚。
