Dengue fever with atypical manifestations in a child with beta thalassemia major post splenectomy

Authors

  • Nidarshana Pandian Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
  • Dhaarani Jayaraman Department of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
  • Naveen Chandher K. Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
  • Sarala Premkumar Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
  • Sudeep Gaddam Department of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
  • Julius X. Scott Department of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20243419

Keywords:

Dengue fever, Dengue with warning signs, Post-splenectomy, Beta-thalassemia major, Anemia

Abstract

Dengue is one of the significant public health concerns in endemic countries. With plasma leakage as the primary pathophysiology in the process of severe dengue infection with hemoconcentration and thrombocytopenia being the significant laboratory diagnostic features in children, the presentation in children with underlying hemato-oncological conditions is atypical and often, anemia is found in these children, instead of hemoconcentration. We describe a young boy with beta thalassemia major who underwent splenectomy for hypersplenism 5-months ago with dengue illness, characterized by features mimicking a severe post splenectomy opportunistic infection with fever, loose stools and abdomen tenderness. Leucopenia, thrombocytopenia, minimal pleural effusion, ascites and gall bladder wall edema prompted us to think of dengue and was found to be positive. Child improved with appropriate supportive care measures. Pediatricians should be aware of the differences in the presentation of tropical infections in children with hemato-oncological disorders. Tropical infections should be kept in mind even in children with underlying hemato-oncological conditions, to ensure diagnosis and appropriate management.

References

Tayal A, Kabra SK, Lodha R. Management of Dengue: An Updated Review. Indian J Pediatr. 2023;90(2):168-77.

World Health Organization, Special Programme for Research, Training in Tropical Diseases, World Health Organization. Department of Control of Neglected Tropical Diseases, World Health Organization. Epidemic, Pandemic Alert. Dengue: guidelines for diagnosis, treatment, prevention and control. 2009. Available at: https://www.who.int/ publications/i/item/9789241547871. Accessed on 12 August 2024.

Dinand V, Metzler V, Yadav SP, Sachdeva A. Atypical dengue Fever in a splenectomized boy with glucose-6- phosphodehydrogenase deficiency and thalassemia intermedia. Indian J Pediatr. 2011;78(4):482-4.

Pongtanakul B, Narkbunnam N, Veerakul G, Sanpakit K, Viprakasit V, Tanphaichitr VT, et al. Dengue hemorrhagic fever in patients with thalassemia. J Med Assoc Thai. 2005;88(8):S80-5.

Chuansumrit A, Natesirinilkul R, Pongtanakul B, Tangnararatchakit K, Sirachainan N, Tantiworavit A, et al. Dengue Infection in Pediatric Patients with Thalassemia: Aggravation of Anemia. Southeast Asian J Trop Med Public Health. 2012;43(2):311-22.

Padyana M, Gopaldas JA, Karanth S. A stitch in time – dengue with spontaneous splenic rupture. Radiol Infect Dis. 2020;7(3):145-8.

Ungthammakhun C, Chueansuwan W, Changpradub D. Dengue Hemorrhagic Fever Complicated with Spontaneous Rupture of the Spleen among Patients with Thalassemia and G6PD Deficiency: A Case Report. Arch Clin Med Case Rep. 2021;5:873-7.

Bhamarapravati N, Tuchinda P, Boonyapaknavik V. Pathology of Thailand haemorrhagic fever: a study of 100 autopsy cases. Ann Trop Med Parasitol. 1967;61:500-10.

Pungjitprapai A, Tantawichien T. A fatal case of spontaneous rupture of the spleen due to dengue virus infection: case report and review. Southeast Asian J Trop Med Public Health. 2008;39:383.

Jirillo E, Mastronardi ML, Altamura M, Munno I, Miniello S, Urgesi G, et al. The immunocompromised host: immune alterations in splenectomized patients and clinical implications. Curr Pharm Des. 2003;9(24):1918-23.

Blackley S, Kou Z, Chen H, Quinn M, Rose RC, Schlesinger JJ, et al. Primary human splenic macrophages, but not T or B cells, are the principal target cells for dengue virus infection in vitro. J Virol. 2007;81(24):13325-34.

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Published

2024-11-08

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Section

Case Reports