Dengue Fever Associated Haemophagocytic Lymphohistiocytosis: A Report of Two Children

Hemophagocytic lymphohistiocytosis (HLH) is a rare, fatal complication of dengue infection and often leads to multi-system involvement and failure. Early recognition is crucial in improving the outcome. We report two children who developed secondary haemophagocytic lymphohistiocytosis following dengue fever. A 14-year-old girl who was diagnosed with beta-thalassemia major presented with dengue hemorrhagic fever and developed a continuous very high fever, persistent thrombocytopenia, and anemia despite several transfusions of blood and blood products. The other child was a 12-year old girl who, following initial confirmation of dengue fever, presented with persistent fever and hepatosplenomegaly. The diagnosis of HLH in both children was confirmed by clinical and laboratory features supported by the demonstration of haemophagocytes in the bone marrow. Both children were treated with steroids and supportive care and made a gradual recovery with treatment. Second-line immune-suppressive treatment was not needed. Whilst sepsis is a priority differential diagnosis in children with persistent fever following recovery from dengue fever, HLH should always be suspected early in these patients. Early, appropriate immunosuppressive treatment is likely to improve long-term outcomes and prevent mortality.