Dengue Hemorrhagic Fever and Non Immune Hemolytic Anemia: Two Recherché in Alliance

Abstract

Dengue is a prevalent arthropod-borne viral disease in tropical and subtropical areas of the globe. Dengue clinical manifestations include asymptomatic infections; undifferentiated fever; dengue fever, which is characterized by fever, headache, retro orbital pain, myalgia, and arthralgia; and a severe form of the disease denominated dengue hemorrhagic fever/dengue shock syndrome, characterized by hemoconcentration, thrombocytopenia, and bleeding tendency. However, atypical manifestations, such as liver, central nervous system, and cardiac involvement, have been increasingly reported called expanded dengue syndrome. We report a 42 years old lady with atypical and rare presentation of dengue disease marked by non immune hemolysis following the critical phase of infection. Condition improved after conservative treatment. Hematological complications in dengue are now increasingly observed with the most common case is cytopenias and bleeding. Non immune hemolytic anemia in dengue is self-limiting in almost all cases. The main mechanism of hemolysis is still unknown though both direct viral infection and immune mediated damage have been suggested to be the cause. To avoid otherwise preventable morbidity and mortality, physicians should have a high index of suspicion for hematological complications in patients with dengue illness and should manage this accordingly.