Thrombotic Microangiopathy in Dengue Fever: A Case Report Highlighting Conservative Management and Recovery

Shanmathi R¹, Rajprabha², Prem kumar J³, Rajashree V ⁴*

This case determines the rare occurrence of thrombotic microangiopathy in dengue fever, emphasizing the need for awareness and early diagnosis.

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.

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