Dengue complicated with HLH syndrome – A case series

Dengue fever, an Aedes mosquito borne arboviral illness, exhibits broad range of symptoms, ranging from mild flu-like manifestation to serious hemorrhagic fever, dengue shock syndrome. Secondary Hemophagocytic Lymphohistiocytosis (HLH) Syndrome is a rare but potentially lethal complication, unless recognized very early stage and may evolve as complication of severe dengue. Diagnostic criteria of HLH fulfilled when 5 out of 8 criteria seen as: Fever>38.5degre celcius for 7 days or more;Hepatosplenomegaly;Cytopenia affecting 2 or more lineage as Hb < 9gm/dl, platelets 265mg/dl)and /or Hypofibrinogenemia ( level 500microgm/L;Soluble CD25 > 2400Unit/ml. 5 cases of Dengue associated with HLH diagnosed in our hospital in 2021 -2022 outbreak with persistent fever( 7 days or more), hepatosplenomegaly, cytopenia, raised Ferritin level(>10,000ng/L), hypertriglyeridemia, hypofibrinogenemia are presented here. However a short course of dexamethasone has made an uneventful recovery in all 5 cases.