Secondary Hemophagocytic Lymphohistiocytosis with Severe Dengue: A Rare but Dreadful Complication
Hemophagocytic lymphohistiocytosis (HLH) is a devastating and rare multisystemic disorder characterized by an autoimmune phenomenon leading to reactive hyperactivity of cytotoxic T cells and histiocytes mediated by cytokine storm. HLH could be primary (hereditary) or secondary (acquired). Unremitten...
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Jaypee Brothers Medical Publisher
2023-12-01
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| Series: | Pediatric Infectious Disease |
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| Online Access: | https://www.pidjournal.com/doi/PID/pdf/10.5005/jp-journals-10081-1412 |
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| author | Ashwani K Sood Saguna Pandit Nidhi Chadha Naresh I Jindal |
| author_facet | Ashwani K Sood Saguna Pandit Nidhi Chadha Naresh I Jindal |
| author_sort | Ashwani K Sood |
| collection | DOAJ |
| description | Hemophagocytic lymphohistiocytosis (HLH) is a devastating and rare multisystemic disorder characterized by an autoimmune phenomenon leading to reactive hyperactivity of cytotoxic T cells and histiocytes mediated by cytokine storm. HLH could be primary (hereditary) or secondary (acquired). Unremittent fever, organomegaly, lymphadenopathy, and neurologic dysfunction are among the common manifestations of HLH, along with abnormal lab parameters like hyperferritinemia, hypertriglyceridemia, hypofibrinogenemia, and transaminitis.
We report a case of a 16-year-old adolescent girl presenting to the emergency department with a history of high-grade fever, with partial response to antipyretics, body aches, and severe headache for 4 days. The physical examination revealed significant hepatomegaly. enzyme-linked immunosorbent assay was positive for dengue nonstructural protein 1 (NS1) antigen (Ag) assay. The patient was managed as per the World Health Organization (WHO) protocol and started improving from dengue; however, during the second week of the illness, the patient continued to have persistent fever. A repeat lab workup revealed bicytopenia with elevated ferritin levels (17891 ng/mL). Diagnosing dengue-associated HLH is challenging unless the treating team is aware of this association, as early recognition and timely institution of immunosuppressive and specific therapy for the underlying infection is associated with improved outcomes. Physicians should collaborate with pathologists and microbiologists for early diagnosis. |
| format | Article |
| id | doaj-art-37f34a359d6f45e2bb1aa0d56a1174ad |
| institution | Kabale University |
| issn | 2582-4988 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | Jaypee Brothers Medical Publisher |
| record_format | Article |
| series | Pediatric Infectious Disease |
| spelling | doaj-art-37f34a359d6f45e2bb1aa0d56a1174ad2025-08-20T03:39:15ZengJaypee Brothers Medical PublisherPediatric Infectious Disease2582-49882023-12-015413513710.5005/jp-journals-10081-14127Secondary Hemophagocytic Lymphohistiocytosis with Severe Dengue: A Rare but Dreadful ComplicationAshwani K Sood0Saguna Pandit1Nidhi Chadha2Naresh I Jindal3Ashwani K Sood, Department of Pediatrics, MM Institute of Medical Sciences & Research, Mullana, Haryana, India, Phone: +91 9418300888Department of Pediatrics, MM Institute of Medical Sciences & Research, Mullana, Haryana, IndiaDepartment of Pediatrics, MM Institute of Medical Sciences & Research, Mullana, Haryana, IndiaDepartment of Pediatrics, MM Medical College, Sadopur, Ambala, Haryana, IndiaHemophagocytic lymphohistiocytosis (HLH) is a devastating and rare multisystemic disorder characterized by an autoimmune phenomenon leading to reactive hyperactivity of cytotoxic T cells and histiocytes mediated by cytokine storm. HLH could be primary (hereditary) or secondary (acquired). Unremittent fever, organomegaly, lymphadenopathy, and neurologic dysfunction are among the common manifestations of HLH, along with abnormal lab parameters like hyperferritinemia, hypertriglyceridemia, hypofibrinogenemia, and transaminitis. We report a case of a 16-year-old adolescent girl presenting to the emergency department with a history of high-grade fever, with partial response to antipyretics, body aches, and severe headache for 4 days. The physical examination revealed significant hepatomegaly. enzyme-linked immunosorbent assay was positive for dengue nonstructural protein 1 (NS1) antigen (Ag) assay. The patient was managed as per the World Health Organization (WHO) protocol and started improving from dengue; however, during the second week of the illness, the patient continued to have persistent fever. A repeat lab workup revealed bicytopenia with elevated ferritin levels (17891 ng/mL). Diagnosing dengue-associated HLH is challenging unless the treating team is aware of this association, as early recognition and timely institution of immunosuppressive and specific therapy for the underlying infection is associated with improved outcomes. Physicians should collaborate with pathologists and microbiologists for early diagnosis.https://www.pidjournal.com/doi/PID/pdf/10.5005/jp-journals-10081-1412case reportcytokine stormdengue feverdengue fever with warning signshemophagocytic lymphohistiocytosis |
| spellingShingle | Ashwani K Sood Saguna Pandit Nidhi Chadha Naresh I Jindal Secondary Hemophagocytic Lymphohistiocytosis with Severe Dengue: A Rare but Dreadful Complication Pediatric Infectious Disease case report cytokine storm dengue fever dengue fever with warning signs hemophagocytic lymphohistiocytosis |
| title | Secondary Hemophagocytic Lymphohistiocytosis with Severe Dengue: A Rare but Dreadful Complication |
| title_full | Secondary Hemophagocytic Lymphohistiocytosis with Severe Dengue: A Rare but Dreadful Complication |
| title_fullStr | Secondary Hemophagocytic Lymphohistiocytosis with Severe Dengue: A Rare but Dreadful Complication |
| title_full_unstemmed | Secondary Hemophagocytic Lymphohistiocytosis with Severe Dengue: A Rare but Dreadful Complication |
| title_short | Secondary Hemophagocytic Lymphohistiocytosis with Severe Dengue: A Rare but Dreadful Complication |
| title_sort | secondary hemophagocytic lymphohistiocytosis with severe dengue a rare but dreadful complication |
| topic | case report cytokine storm dengue fever dengue fever with warning signs hemophagocytic lymphohistiocytosis |
| url | https://www.pidjournal.com/doi/PID/pdf/10.5005/jp-journals-10081-1412 |
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