Thrombotic Microangiopathy in Dengue Fever: A Case Report Highlighting Conservative Management and Recovery
Shanmathi R1, Rajprabha2, Prem kumar J3, Rajashree V 4*
Journal of Angiotherapy 6(1) 1-5 https://doi.org/10.25163/angiotherapy.6162194291010122
Submitted: 29 November 2021 Revised: 09 December 2021 Published: 10 January 2022
Abstract
Background: Dengue fever, caused by the dengue virus and transmitted by Aedes mosquitoes, is prevalent in tropical and subtropical regions. Although most infections are mild or asymptomatic, severe cases can lead to complications such as acute kidney injury (AKI). Thrombotic microangiopathy (TMA) is a rare but severe complication associated with dengue fever. Methods: This case reports a 32-year-old male diagnosed with dengue fever through non-structural protein 1 (NS1) antigen testing. Initial management included intravenous fluids. As the patient’s condition deteriorated, he developed symptoms including reduced urine output, dyspnea, pallor, and generalized swelling. Investigations included laboratory tests, kidney ultrasound, and biopsy. Results: Diagnostic tests revealed anemia, thrombocytopenia, elevated serum creatinine, and significantly elevated lactate dehydrogenase (LDH). Kidney biopsy confirmed TMA with glomerular capillary microthrombi and fibrillary changes. The patient was treated with hemodialysis and conservative measures. Despite the severity, he recovered without plasmapheresis. Conclusion: This case highlights the rare complication of TMA in dengue fever and demonstrates that conservative management can be effective. Recognizing such atypical presentationsis crucial for early diagnosis and appropriate management, which is essential in preventing severe complications and improving patient outcomes.
Keywords: Dengue fever, Thrombotic microangiopathy, Acute kidney injury, Complement activation, Hemodialysis.
References
Aroor, S., Kumar, S., Mundkur, S., & Kumar, M. (2014). Hemolytic uremic syndrome associated with dengue fever in an adolescent girl. Indian Journal of Pediatrics, 81(12), 1397–1398. https://doi.org/10.1007/s12098-014-1368-9
Barnabeu, A. I. A., Escribano, T. C., & Vilarino, M. C. (2020). Atypical hemolytic uremic syndrome: New challenges in the complement blockage era. Nephron, 144(11), 537–549. https://doi.org/10.1159/000508920
Bastos, M. L. A., De Araújo, R. M. O., Oliveira, D. D. S., Cavalcante, A. N. M., & Junior, G. B. D. S. (2018). Thrombotic thrombocytopenic purpura associated with dengue and chikungunya virus coinfection: Case report during an epidemic period. Revista do Instituto de Medicina Tropical de São Paulo, 60, e48. https://doi.org/10.1590/s1678-9946201860048
Brocklebank, V., Wood, K. M., & Kavanagh, D. (2017). Thrombotic microangiopathy and the kidney. Clinical Journal of the American Society of Nephrology, 13(2), 300–317. https://doi.org/10.2215/CJN.00620117
Campistol, J. M., Arias, M., Ariceta, G., Blasco, M., Espinosa, L., Espinosa, M., et al. (2015). Actualización en síndrome hemolítico urémico atípico: Diagnóstico y tratamiento. Nefrología, 35(5), 421–516. https://doi.org/10.1016/j.nefro.2015.07.005
Deepanjali, S., Naik, R. R., Mailankody, S., Kalaimani, S., & Kadhiravan, T. (2015). Dengue virus infection triggering thrombotic thrombocytopenic purpura in pregnancy. American Journal of Tropical Medicine and Hygiene, 93(5), 1028–1030. https://doi.org/10.4269/ajtmh.15-0326
Gupta N, Srivastava S, Jain A, Chaturvedi UC. 2012. Dengue in India. Indian J Med Res 2012;136:373-90.
Hadianto, M. T., & Mellyana, O. (2001). Hemolytic uremic syndrome and hypertensive crisis post dengue hemorrhagic fever: A case report. Pediatria Indonesiana, 51(6), 372–376.
Khalil MA, Sarwar S, Chaudry MA, Maqbool B, Khalil Z, Tan J, et al. 2012. Acute kidney injury in dengue virus infection. Clin Kidney J 2012;5:390-4.
Lima-Camara, T. N. (2016). Arboviroses emergentes e novos desafios para a saúde pública no Brasil. Revista de Saúde Pública, 50, 36. https://doi.org/10.1590/S1518-8787.2016050006791
Nieto-Ríos, J. F., Barreneche, M. F. A., Penagos, S. C., Márquez, D. C. B., Serna-Higuita, L. M., & Sánchez, I. C. R. (2018). Successful treatment of thrombotic microangiopathy associated with dengue infection: A case report and literature review. Transplant Infectious Disease, 20(1), e12824. https://doi.org/10.1111/tid.12824
Upadhaya BK, Sharma A, Khaira A, Dinda AK, Agarwal SK, Tiwari SC. 2010. Transient IgA nephropathy with acute kidney injury in a patient with dengue fever. Saudi J Kidney Dis Transpl 2010;21:521-5.
World Health Organization. (2009). Dengue: Guidelines for diagnosis, treatment, prevention and control (pp. 1–147). Geneva: World Health Organization.
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