Haemophagocytic syndrome secondary to severe dengue. A case report

Abstract

Introduction: Haemophagocytic lymphohistiocytosis (HLH) is a rare, severe pathology in which there is an exaggerated immune response resulting in a hyperinflammatory state. It may be primary or secondary to infections, metabolopathies, neoplasia, etc. Case report: We present the case of a patient with severe dengue with anaemising gastrointestinal bleeding, abdominal compartment syndrome secondary to ascites, hepatic and renal failure and neurological dysfunction, requiring admission to the intensive care unit for management. Due to the persistence of fever and poor evolution, further investigation confirmed the diagnosis of HLH, and immunomodulatory treatment was initiated. Finally, despite therapeutic efforts, the patient died. Discusion and conclusions: This reminds us of the importance of identifying the warning signs of the development of severe dengue according to WHO-2009 criteria in order to transfer the patient to a reference centre for appropriate management. In addition, it is essential to establish a high index of suspicion for HLH in severe patients with prolonged fever and the presence of possible triggers, enabling the diagnosis to be made according to the HLH-2004 criteria and to initiate treatment directed against the trigger and immunomodulator to reduce the hyperinflammatory state.