Oral Etoposide for Dengue Induced Haemophagocytic Lymphohistiocytosis Presented as Acute Liver Failure

Abstract

Dengue fever is not an uncommon arboviral infection in lieu of tropical geography. The gravity of the disease ranges from an Outpatient Department (OPD) visits for febrile illness to haemorrhagic complications like shock. Hereby, authors report a case of a 33-year-old female patient with no prior morbidities. Initial fever episodes due to dengue resulted but she deteriorated clinically with second wave of continuous fever spikes. On evaluation, a diagnosis of Haemophagocytic Lymphohistiocytosis (HLH) was made. The patient was treated with steroids and oral etoposide following which patient recovered completely. Although, scarce occurrence of HLH following viral illness needs strong suspicion, prompt investigation and management to avoid potentially life-threatening complications. On a case-to-case basis HLH protocol can be modified to make an OPD base treatment by switching to oral etoposide.

Keywords

• chemotherapy
• cytopenia
• haemophagocytic syndrome
• macrophage activation syndrome