Dengue fever in a patient with severe haemophilia: a case report

BACKGROUND: Dengue fever is the most rapidly spreading mosquito-borne viral disease in the world. Haemophilia A is the commonest inherited bleeding disorder. There is little data on the incidence and outcome of dengue in patients with haemophila. We report a case of a patient with severe haemophila A, presenting with dengue fever, managed at a tertiary care hospital in Sri Lanka. CASE PRESENTATION: A 16-year-old Sinhalese male with severe haemophilia A (factor level < 1percent) was admitted to a teaching hospital in Sri Lanka on day 1 of an acute febrile illness, associated with arthralgia, myalgia, vomiting and headache. On admission, he had a tachycardia of 120 beats per minute, and blood pressure of 110/70 millimetres of mercury, with no bleeding manifestations. Baseline investigations revealed leukocyte and platelet counts of 4400 and 241,000 per cubic millimtre, respectively, and a haematocrit of 34.5 percent. Dengue was confirmed later by sero-conversion of the dengue IgM antibody test. Fluid balance, pulse rate and blood pressure were monitored hourly. The haematocrit and platelet counts were checked thrice daily, while he was clinically assessed for bleeding. On day 3 he developed bleeding from a tooth extraction site, with vomiting of dark red blood. His platelet level at that point was 124,000 per cubic millimetre with a haematocrit of 32 percent. Intravenous factor VIII was given to achieve a 100 percent factor correction over twenty-four hours. His platelet count dropped progressively from admission to a nadir of 50,000 per cubic millimetre on day 6. He did not develop clinical evidence of fluid leakage. On day 7 he was discharged after complete recovery. CONCLUSIONS: People with haemophilia may exhibit bleeding from the early febrile stage and at higher platelet levels than most other patients with dengue. Further discussion and research is necessary to decide on the optimal management of these patients, with regard to monitoring and timely treatment with blood products and/or factor correction, in order to prevent dengue-related morbidity and mortality whilst avoiding overtreatment. In endemic areas it is advisable that such patients seek early medical help in the event of an acute fever.