Multisystem Complications of Dengue Encephalitis: Addressing Hemophagocytic Lymphohistiocytosis (HLH) – A Case Report
DOI:
https://doi.org/10.26463/rjns.15_2_1Keywords:
Dengue encephalitis, Type 2 diabetes mellitus, Elderly female, Hemophagocytic Lymphohistio-cytosis, Intensive careAbstract
Dengue encephalitis is uncommon, as neurological involvement is a rare complication of dengue fever. Neurological, hematological, and cardiac manifestations can occur, presenting a challenging clinical scenario. This report describes an elderly female with a decade-long history of type 2 diabetes mellitus who presented with dengue encephalitis, complicated by hemophagocytic lymphohistiocytosis (HLH) and cardiac arrhythmias. The initial symptoms led to a diagnosis of dengue encephalitis, confirmed by positive dengue IgM and MRI brain findings. Her condition subsequently deteriorated, necessitating recurrent hospitalizations and the development of both supraventricular and ventricular tachycardia, requiring advanced cardiac life support (ACLS). Despite intensive care and clinical stabilization, persistently elevated inflammatory markers, including elevated C-reactive protein (CRP), indicated ongoing systemic inflammation. This case highlights the complexities involved in managing severe dengue infection in elderly diabetic patients.
References
1. Dengue: Guidelines for diagnosis, treatment, prevention and control. Geneva: World Health Organization; 2009. Available from: https://pubmed. ncbi.nlm.nih.gov/23762963/
2. Solomon T, Dung NM, Vaughn DW, et al. Neurological manifestations of dengue infection. Lancet 2000;355(9209):1053-1059.
3. Jordan MB, Allen CE, Weitzman S, et al. How I treat hemophagocytic lymphohistiocytosis. Blood 2011;118(15):4041-4052.
4. Fries W, Cottone M, Cascio A. Systematic review: macrophage activation syndrome in inflammatory bowel disease. Aliment Pharmacol Ther 2013;37(11):1033-45.
5. Page RL, Joglar JA, Caldwell MA, et al. ACC/AHA/ HRS guideline for the management of adult patients with supraventricular tachycardia. Circulation 2015;133(14):e506-e574.
6. Moallemi S, Lloyd AR, Rodrigo C. Early biomarkers for prediction of severe manifestations of dengue fever: A systematic review and a meta-analysis. Sci Rep 2023;13(1):17485.
