Abstract
Introduction: Dengue hemorrhagic fever(DHF) is an acute disease caused by dengue virus. Pulmonary hemorrhage and hemoptysis are rarely reported in DHF. We present a similar unique & rare case.
Case presentation: 18 year-old boy came with 7 days history of fever, hemoptysis & dyspnoea. He was febrile with small ecchymosis on arms. Pulse 120/m, respiratory rate 34/m ,BP 98/60 mm Hg. Crackles heard bilaterally. Hb 7.6 gm, hematocrit 24.5%, platelets 30000, WBC 3500 with a normal differential. DHF was suspected. Dengue IgM and IgG were positive. CT thorax showed areas of ground glass haziness. BAL- plenty of hemosiderin laden macrophages. Thus a diagnosis of DHF with pulmonary alveolar hemorrhage was arrived at. Patient received multiple transfusions & intensive care but developed severe respiratory distress with shock & died 10 days later.
Discussion: As per WHO guidelines, our patient fulfilled criteria for DHF: fever of 2-7 days,hemorrhagic tendencies, echhymosis and hemoptysis, thrombocytopenia < 100,000 and other signs of dengue fever like leucopenia and positive IgM. Pleural effusions & pneumonitis are uncommon and DHF with pulmonary hemorrhage is even more rare.Only two cases of pulmonary hemorrhage and hemoptysis in DHF are reported so far. Our patient had a fulminant course and died of dengue hemorrhagic shock(DSS)
Conclusion: DHF with pulmonary hemorrhage is very rare complication and mortality is high.
- Copyright ©the authors 2016