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Secondary dengue serotype 1 infection causing dengue shock syndrome with rhombencephalitis and bleeding associated with refractory thrombocytopenia: A case report

BACKGROUND: Dengue has a wide spectrum of manifestations, from an asymptomatic condition to dengue shock syndrome. Extensive plasma leakage, severe bleeding, or both, could lead to dengue shock syndrome, a common cause of death in dengue-infected patients. Thrombocytopenia is a common laboratory fin...

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Autores principales: Surabotsophon, Manoon, Laohachavalit, Poonsak, Ponglikitmongkol, Sunsern, Chuncharunee, Suporn, Sudsang, Thanwa, Thanachartwet, Vipa, Sahassananda, Duangjai, Hunsawong, Taweewun, Klungthong, Chonticha, Fernandez, Stefan, Kalayanarooj, Siripen, Desakorn, Varunee, Leelasetakul, Suthee
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10333608/
https://www.ncbi.nlm.nih.gov/pubmed/37441400
http://dx.doi.org/10.1016/j.heliyon.2023.e17419
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author Surabotsophon, Manoon
Laohachavalit, Poonsak
Ponglikitmongkol, Sunsern
Chuncharunee, Suporn
Sudsang, Thanwa
Thanachartwet, Vipa
Sahassananda, Duangjai
Hunsawong, Taweewun
Klungthong, Chonticha
Fernandez, Stefan
Kalayanarooj, Siripen
Desakorn, Varunee
Leelasetakul, Suthee
author_facet Surabotsophon, Manoon
Laohachavalit, Poonsak
Ponglikitmongkol, Sunsern
Chuncharunee, Suporn
Sudsang, Thanwa
Thanachartwet, Vipa
Sahassananda, Duangjai
Hunsawong, Taweewun
Klungthong, Chonticha
Fernandez, Stefan
Kalayanarooj, Siripen
Desakorn, Varunee
Leelasetakul, Suthee
author_sort Surabotsophon, Manoon
collection PubMed
description BACKGROUND: Dengue has a wide spectrum of manifestations, from an asymptomatic condition to dengue shock syndrome. Extensive plasma leakage, severe bleeding, or both, could lead to dengue shock syndrome, a common cause of death in dengue-infected patients. Thrombocytopenia is a common laboratory finding in dengue, which correlates with the disease severity and rapidly resolves during the recovery phase. Therefore, refractory thrombocytopenia is rare in patients with dengue. Rhombencephalitis is an inflammatory disease affecting the hindbrain, rarely associated with dengue. We report the second case of dengue-associated rhombencephalitis, wherein the patient developed dengue shock syndrome and severe bleeding associated with refractory thrombocytopenia. CASE REPORT: A 47-year-old Thai female with secondary dengue serotype 1 infection developed dengue shock syndrome with rhombencephalitis, manifested as altered sensorium and status epilepticus in the critical phase. Cerebrospinal fluid analysis showed pleocytosis with predominantly mononuclear cells and high protein levels. Magnetic resonance imaging of the brain showed multifocal brain signal abnormalities involving the medulla oblongata, pons, midbrain, bilateral hippocampi, thalami, posterior limb of internal capsules, external capsules, and deep hemispheric white matter. The patient had partial neurological recovery following rhombencephalitis for one month. During the recovery phase, severe bleeding with refractory thrombocytopenia and acute kidney injury were observed. Methylprednisolone with eltrombopag was administered, which resulted in an increased the platelet count, cessation of bleeding and recovery of kidney function within 4 days. CONCLUSIONS: Dengue is a potential cause of rhombencephalitis. Dengue-associated rhombencephalitis develops during the critical phase, with only partial neurological recovery. However, severe bleeding and refractory thrombocytopenia were also observed during the recovery phase. Methylprednisolone with a thrombopoietin receptor agonist could be an effective treatment for increasing platelet count and stopping bleeding in dengue.
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spelling pubmed-103336082023-07-12 Secondary dengue serotype 1 infection causing dengue shock syndrome with rhombencephalitis and bleeding associated with refractory thrombocytopenia: A case report Surabotsophon, Manoon Laohachavalit, Poonsak Ponglikitmongkol, Sunsern Chuncharunee, Suporn Sudsang, Thanwa Thanachartwet, Vipa Sahassananda, Duangjai Hunsawong, Taweewun Klungthong, Chonticha Fernandez, Stefan Kalayanarooj, Siripen Desakorn, Varunee Leelasetakul, Suthee Heliyon Case Report BACKGROUND: Dengue has a wide spectrum of manifestations, from an asymptomatic condition to dengue shock syndrome. Extensive plasma leakage, severe bleeding, or both, could lead to dengue shock syndrome, a common cause of death in dengue-infected patients. Thrombocytopenia is a common laboratory finding in dengue, which correlates with the disease severity and rapidly resolves during the recovery phase. Therefore, refractory thrombocytopenia is rare in patients with dengue. Rhombencephalitis is an inflammatory disease affecting the hindbrain, rarely associated with dengue. We report the second case of dengue-associated rhombencephalitis, wherein the patient developed dengue shock syndrome and severe bleeding associated with refractory thrombocytopenia. CASE REPORT: A 47-year-old Thai female with secondary dengue serotype 1 infection developed dengue shock syndrome with rhombencephalitis, manifested as altered sensorium and status epilepticus in the critical phase. Cerebrospinal fluid analysis showed pleocytosis with predominantly mononuclear cells and high protein levels. Magnetic resonance imaging of the brain showed multifocal brain signal abnormalities involving the medulla oblongata, pons, midbrain, bilateral hippocampi, thalami, posterior limb of internal capsules, external capsules, and deep hemispheric white matter. The patient had partial neurological recovery following rhombencephalitis for one month. During the recovery phase, severe bleeding with refractory thrombocytopenia and acute kidney injury were observed. Methylprednisolone with eltrombopag was administered, which resulted in an increased the platelet count, cessation of bleeding and recovery of kidney function within 4 days. CONCLUSIONS: Dengue is a potential cause of rhombencephalitis. Dengue-associated rhombencephalitis develops during the critical phase, with only partial neurological recovery. However, severe bleeding and refractory thrombocytopenia were also observed during the recovery phase. Methylprednisolone with a thrombopoietin receptor agonist could be an effective treatment for increasing platelet count and stopping bleeding in dengue. Elsevier 2023-06-17 /pmc/articles/PMC10333608/ /pubmed/37441400 http://dx.doi.org/10.1016/j.heliyon.2023.e17419 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Surabotsophon, Manoon
Laohachavalit, Poonsak
Ponglikitmongkol, Sunsern
Chuncharunee, Suporn
Sudsang, Thanwa
Thanachartwet, Vipa
Sahassananda, Duangjai
Hunsawong, Taweewun
Klungthong, Chonticha
Fernandez, Stefan
Kalayanarooj, Siripen
Desakorn, Varunee
Leelasetakul, Suthee
Secondary dengue serotype 1 infection causing dengue shock syndrome with rhombencephalitis and bleeding associated with refractory thrombocytopenia: A case report
title Secondary dengue serotype 1 infection causing dengue shock syndrome with rhombencephalitis and bleeding associated with refractory thrombocytopenia: A case report
title_full Secondary dengue serotype 1 infection causing dengue shock syndrome with rhombencephalitis and bleeding associated with refractory thrombocytopenia: A case report
title_fullStr Secondary dengue serotype 1 infection causing dengue shock syndrome with rhombencephalitis and bleeding associated with refractory thrombocytopenia: A case report
title_full_unstemmed Secondary dengue serotype 1 infection causing dengue shock syndrome with rhombencephalitis and bleeding associated with refractory thrombocytopenia: A case report
title_short Secondary dengue serotype 1 infection causing dengue shock syndrome with rhombencephalitis and bleeding associated with refractory thrombocytopenia: A case report
title_sort secondary dengue serotype 1 infection causing dengue shock syndrome with rhombencephalitis and bleeding associated with refractory thrombocytopenia: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10333608/
https://www.ncbi.nlm.nih.gov/pubmed/37441400
http://dx.doi.org/10.1016/j.heliyon.2023.e17419
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