Title : Rare complication of dengue fever: Severe acute liver failure – Case report
Abstract:
Elevated liver enzymes occur in up to 50 to 90% of patients with dengue, usually with a slight elevation and no clinical significance. In severe cases, the elevation can reach up to ten times the normal value, associated with severe liver inflammation and liver failure in about 0.35% of cases. A 31-year-old female patient, brown-skinned, with no comorbidities, was admitted to the emergency room with myalgia, abdominal pain, nausea, vomiting, and diarrhea that had been present for three days. Laboratory tests showed leukopenia, thrombocytopenia, elevated liver enzymes, and hyperbilirubinemia, and she was referred to an infectious disease hospital for suspected dengue fever. Chest and abdominal CT scans showed pleural and pericardial effusions and ascites, as well as signs of pulmonary inflammation, pulmonary congestion, splenomegaly, and acalculous cholecystitis. She had severe thrombocytopenia (13,000/mm³), coagulation disorders with prothrombin activity of 50.6% and INR 1.55, hyperbilirubinemia at the expense of the direct fraction (total bilirubin: 2.7 mg/dL and direct: 1.8 mg/dL), elevated inflammatory tests (lactic dehydrogenase: 4855.1 U/L, C-reactive protein: 74.2 mg/L, and ferritin: 2000 ng/mL), and significantly elevated liver enzymes (oxaloacetic transaminase: 7442 U/L and pyruvic transaminase: 2901.7 U/L). Serology tests for human immunodeficiency virus and hepatitis A, B, and C were negative. Rapid testing for dengue NS1 and serology tests for IgG and IgM were reactive, confirming recent infection with the dengue virus via the ELISA method. The patient progressed favorably with resolution of symptoms and organ dysfunction and was discharged after eight days of hospitalization.
