Increase in cases of rare dengue complication: Docs

Hyderabad: Doctors in the city are reporting an increase in cases of an extremely rare but known complication of dengue — Hemophagocytic lymphohistiocytosis (HLH) — in both children and adults this season. While only one or two cases have been reported in the last five years, individual paediatricians have seen three to six cases in the last four weeks alone.
Currently, HLH is being seen in dengue cases, especially when dengue is co-infected with other infections.In most cases, patients require admission to ICU and even ventilator support.

In a recent case, a five-year-old boy referred to a tertiary care centre with severe dengue shock syndrome, secondary HLH and multi-organ dysfunction (MOD) required invasive ventilation and multidisciplinary critical care support before improving. He is currently off the ventilator but in ICU. In another case, a five-year-old girl with severe dengue shock syndrome, secondary HLH, MOD and acute renal failure (ARF) required continuous renal replacement therapy (CRRT).
HLH is a rare, life-threatening disease that occurs when the immune system becomes dysregulated and attacks the body’s own organs. This means patients can be attacked by other viruses at same time, as seen in many cases.
“Some of our patients have had dengue with typhoid and dengue with influenza and ended up with HLH. Before that, we have seen a good number of cases of immune dysregulation caused by Covid-19. In HLH, the immune system becomes dysregulated, leading to organ dysfunction and potentially death,” said Dr Satish Ghanta, intensivist and neonatologist, Little Stars & She Women and Children’s Hospital.
There have also been a few cases of patients being placed on extracorporeal membrane oxygenation, which supports the heart, lungs and kidneys.
While the mortality rate in HLH cases is high, timely intervention can save lives. “The body’s overwhelming response in trying to fight an infection like dengue leads to severe complications, so the treatment is different. In such cases, we have to give steroids along with immunoglobulins to control over-response. With more such cases coming up, there is a need to remain vigilant,” said Dr Gandham Sneha, Consultant Internal Medicine, Care Hospitals.