HEMOPHAGOCYTOSIS: AN UNUSUAL COMPLICATION OF CLASSICAL DENGUE FEVER WITH ACUTE LIVER FAILURE.

2021 ◽  
pp. 104-105
Author(s):  
Deepa Sharnagat ◽  
Vishal Sawant ◽  
Alpana Kondekar
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Dengue Fever ◽  
Unusual Case ◽  
Clinical Symptoms ◽  
Rare Complication ◽  
Dengue Shock Syndrome ◽  
Unusual Complication ◽  
Life Threatening ◽  
Vector Borne

Dengue is a vector-borne disease caused by dengue virus. It has a diverse presentation and usually presents as an asymptomatic, self-limiting disease. Among the unusual presentations, hepatic dysfunction is well reported. Complications of dengue fever can be protean and life-threatening. Dengue may cause bone marrow suppression leading to thrombocytopenia, leukopenia and anemia in acute phase of illness; and increased hematocrit due to capillary leakage, but these changes are self-limiting and require no further investigations and specic treatment. Dengue associated Hemophagocytic lymphohistiocytosis (HLH) is a rare complication of Dengue haemorrhagic fever or Dengue shock syndrome. Diagnosis of secondary HLH (sHLH) due to dengue is usually challenging and delayed as initial clinical symptoms mimic sepsis and systemic inammatory response syndrome (SIRS). Delayed or no treatment of sHLH has a poor outcome. We present an unusual case of classical dengue fever presented as Acute liver failure (ALF) with encephalopathy, later complicated by sHLH.

scholarly journals Dengue fever complicated with acute liver failure: A case report of expanded dengue syndrome and literature review

2020 ◽  
Vol 8 ◽  
pp. 2050313X2091342 ◽  
Author(s):  
Navaneethakrishnan Suganthan ◽  
Gajawathana Sakthilingham ◽  
Thirunavukarasu Kumanan
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Dengue Fever ◽  
Dengue Infection ◽  
Dengue Shock Syndrome ◽  
Acute Hepatic Failure ◽  
Fresh Frozen Plasma ◽  
Uneventful Recovery ◽  
Fresh Frozen ◽  
Plasma Leakage

Dengue is the most common arboviral disease, the presentation of which ranges from asymptomatic illness to dengue shock syndrome. Liver is the most common organ affected in dengue, and liver involvement is asymptomatic in majority. Dengue fever is a rare, but a leading cause for acute liver failure in endemic regions. Here, we report a case of a 34-year-old male ethanol user (16 units per week), presented with typical features of dengue infection, which was confirmed serologically, complicated with acute liver failure without clinical, radiological or laboratory evidence of plasma leakage. He was managed with intravenous fresh frozen plasma and N-acetyl cysteine along with other recommended supportive therapies for acute hepatic failure. He made an uneventful recovery.

scholarly journals A Case of Exertional Heat Stroke Complicated by Hypoxic Hepatitis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Bertram K. Woitok ◽  
Shawki Bahmad ◽  
Gregor Lindner
Keyword(s):  
Supportive Care ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Multiorgan Failure ◽  
Heat Stroke ◽  
Exertional Heat Stroke ◽  
Hypoxic Hepatitis ◽  
Threatening Condition ◽  
Life Threatening ◽  
Delayed Referral

Background.Exertional heat stroke is a life-threatening condition often complicated by multiorgan failure. We hereby present a case of a 25-year-old male presenting with syncope after a 10  km run in 28°C outside temperature who developed acute liver failure. Case Presentation. Initial temperature was found to be 41.1°C, and cooling measures were rapidly applied. He suffered from acute renal failure and rhabdomyolysis and proceeded to acute liver failure (ASAT 6100 U/l and ALAT 6561 U/l) due to hypoxic hepatitis on day 3. He did not meet criteria for emergency liver transplantation and recovered on supportive care. Conclusions. Acute liver failure due to heat stroke is a life-threatening condition with often delayed onset, which nevertheless resolves on supportive care in the majority of cases; thus, a delayed referral to transplant seems to be reasonable.

scholarly journals DENGE FEVER IN EMERGENCY MEDICAL PRACTICE

2018 ◽  
Vol 8 (6) ◽  
pp. 430-437
Author(s):  
N. N. Zvereva ◽  
V. A. Kadyshev ◽  
R. F. Sayfullin ◽  
S. V. Smetanina ◽  
M. A. Sayfullin
Keyword(s):  
Dengue Fever ◽  
Viral Vector ◽  
Clinical Symptoms ◽  
Hematological Parameters ◽  
Intensive Therapy ◽  
Working Hours ◽  
Medical Worker ◽  
Medical Organization ◽  
Tropical Countries ◽  
Vector Borne

Due to the increasing number of Russian citizen’s visits to the countries of the tropical countries, the number of cases of imported endemic infectious diseases, mostly dengue fever (DF), also had increased. Dengue fever is an acute viral vector-borne disease, accompanied by fever and intoxication, with the possible development of hemorrhagic syndrome and shock, in which survival depends from the time of initiation of intensive therapy. The greatest incidence of DF in Moscow is associated with travelling to tropical countries during the Christmas holidays, which coincides with the seasonal rise in the incidence of influenza and other ARTI’s. However, ambulance medical workers in most cases (except for the cases of calling the ambulance team to the medical organization during the working hours of the laboratory) are not able to carry out and assess even the minimum of hematological parameters. Therefore, when diagnosing and determining the phase of the disease and its severity, the ambulance medical worker can rely only on epidemiological and clinical data. In this regard, a group of authors proposed an algorithm for early diagnosis and treatment of patients with suspected dengue fever at the prehospital stage, taking into account clinical symptoms and standardized tourniquet test.

scholarly journals Acute Liver Failure in a Patient With Dengue Shock Syndrome

2020 ◽  
Vol 7 (4) ◽  
pp. e00371 ◽  
Author(s):  
Justin Lewis ◽  
Arnab Mitra ◽  
Michael Chang
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Dengue Shock Syndrome

Splenic Rupture: An Unusual Complication of Colonoscopy

2007 ◽  
Vol 73 (4) ◽  
pp. 393-396 ◽  
Author(s):  
Stefan Holubar ◽  
Amit Dwivedi ◽  
J. Eisendorfer ◽  
R. Levine ◽  
R. Strauss
Keyword(s):  
Hemorrhagic Shock ◽  
Splenic Injury ◽  
Early Recognition ◽  
Rare Complication ◽  
Treatment Options ◽  
Unusual Complication ◽  
Angiographic Embolization ◽  
Diagnostic Colonoscopy ◽  
Life Threatening ◽  
Therapeutic Colonoscopy

Splenic injury is a known, albeit rare, complication of diagnostic and therapeutic colonoscopy. Within a 6-month period, we observed two colonoscopic splenic injuries. We report these two cases of splenic injury who presented differently after colonoscopy: one presented as frank hemorrhagic shock, and the other as a subacute splenic hemorrhage with symptomatic anemia. The first patient presented with hemorrhagic shock several hours after a diagnostic colonoscopy and required an emergency splenectomy. The second patient presented with symptomatic anemia several days after a diagnostic colonoscopy and was treated by angiographic embolization. Clinical presentation and discussion of the mechanisms of injury, available treatment options, and strategies for preventing colonoscopic splenic injuries are presented. Awareness of this complication is paramount in early recognition and management of this potentially life-threatening injury.

scholarly journals Panophthalmitis in a patient with dengue fever

2019 ◽  
Vol 12 (6) ◽  
pp. e229588
Author(s):  
Vimal Kumar ◽  
Vaibhav Deorari ◽  
Shekhar Swaroop ◽  
Ashutosh Biswas
Keyword(s):  
Dengue Fever ◽  
Staphylococcus Epidermidis ◽  
Early Stage ◽  
Supportive Therapy ◽  
Unusual Complication ◽  
Life Threatening ◽  
Brain Abscesses ◽  
Multiple Challenges ◽  
The Right ◽  
Spread Of Infection

Dengue fever is known for its life-threatening complications of bleeding and capillary leak syndrome. We report an unusual complication of dengue fever causing panophthalmitis, leading to rapidly progressive painful visual loss within days. Later on, the patient developed secondary bacterial infection of the eyeball and developed multiple brain abscesses due to spread of infection from the eyeball. Culture from pus swab of the right eye grew Staphylococcus epidermidis. The patient was promptly treated with broad spectrum antibiotics and after stabilisation, evisceration of the affected eye was done. Supportive therapy in the form of mechanical ventilation in view of poor sensorium, platelet transfusions for thrombocytopenia and guided fluid therapy was also provided. After multiple challenges in the management of the patient, fortunately, the patient survived but we failed to save his right eye. Therefore, it is necessary to carefully examine all vital organs at an early stage to prevent unfortunate outcome.

scholarly journals ACTION OF VITAMIN E ON EXPERIMENTAL SEVERE ACUTE LIVER FAILURE

2017 ◽  
Vol 54 (2) ◽  
pp. 123-129 ◽  
Author(s):  
Fabiano Moraes MIGUEL ◽  
Elizângela Gonçalves SCHEMITT ◽  
Josieli Raskopf COLARES ◽  
Renata Minuzzo HARTMANN ◽  
Maria Isabel MORGAN-MARTINS ◽  
...  
Keyword(s):  
Vitamin E ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Clinical Syndrome ◽  
Control Group ◽  
Activity Levels ◽  
Liver Functions ◽  
Life Threatening ◽  
Hepatocyte Necrosis ◽  
The One

ABSTRACT BACKGROUND Severe Acute Liver Failure (ALF) is a life-threatening clinical syndrome characterized by hepatocyte necrosis, loss of hepatic architecture, and impairment of liver functions. One of the main causes of ALF is hepatotoxicity from chemical agents, which damage hepatocytes and result in increase of reactive oxygen species. The vitamin E isoform is the one with the strongest biological antioxidant activity. OBJECTIVE To evaluate the antioxidant effect of vitamin E in this ALF model. METHODS We used 56 rats (mean weight of 300 g) divided into eight groups, four groups assessed at 24 hours and 4 assessed at 48 hours after induction: control group (CO); Vitamin E (Vit. E); Thioacetamide (TAA) and Thioacetamide + Vitamina E (TAA+Vit.E). Rats were submitted to injections of thioacetamide (400 mg/kg i.p.) at baseline and 8 hours later. Vitamin E (100 mg/kg ip) was administered 30 minutes after the second dose of thioacetamide. The 48-hour group rats received two additional doses of vitamin E (24h and 36h). At 24h or 48 hours after the administration of the first dose of TAA, rats were weighed and anesthetized and their blood sampled for evaluation of liver integrity through enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Liver tissue was sampled for assessment of lipid peroxidation (LPO) by the technique TBARS, antioxidant enzymes SOD, CAT, GPx and GST activity, levels of the NO 2 /NO 3 and histology by H&E in two times. The results were expressed as mean ± standard deviation and statistically analyzed by ANOVA followed by Student-Newman-Keuls, with P <0.05 considered as significant. RESULTS After treatment with vitamin E, we observed a reduction in liver enzymes AST (U/L) (101.32±19.45 in 24 hours and 97.85±29.65 in 48 hours) related to the TAA group (469.56± 0.69 in 24 hours and 598.23±55.45 in 48 hours) and ALT (U/L) (76.59±8.56 in 24 hours and 68.47±6.49 in 48 hours) compared to the TAA group (312.21±10.23 in 24 hours and 359.15±17.58 in 48 hours). There was a reduction of LPO (nmol/mg Prot) in the TAA+Vit.E group (0.77±0.07 in 24 hours and 0.95±0.08 in 48 hours) compared to the TAA group (1.50±0.07 in 24 hours e 1.65±0.16 in 48 hours). SOD decreased in the TAA+Vit.E group (49.48±9.47 in 24 hours and 62.45±18, 47 in 48 hours), related to the TAA group (98.46±15.48 in 24 hours and 154.13±21.46 in 48 hours), as well as GST (nmol/min/mg Prot) in the TAA+Vit.E group (350.57±36.93 in 24 hours and 453.29±13.84 in 48 hours) compared to the TAA group (561.57±64.56 in 24 hours and 673.43±38.13 in 48 hours). There was an increase in CAT (pmol/min/mg Prot) in the TAA+Vit.E group (3.40±0.44 in 24 hours and 3.0±0.35 in 48 hours) compared to the TAA group (1.65±0.21 in 24 hours and 1.86±0.42 in 48 hours). The GPx (nmol/min/mg Prot) increased in 24 hours in the TAA+Vit.E group (1.01±0.16) compared to the TAA group (0.41±0.04) and decreased in 48 hours (1.19±0.17) compared to the TAA group (1.76±0.21). There was a reduction in NO2/NO3 (mmol/L) levels in the TAA+Vit.E group (31.47±4.26 in 24 hours and 38.93±5.20 in 48 hours) compared to the TAA group (49.37±5.12 in 24 hours and 53.53±5.97 in 48 hours). The histopathological evaluation showed a decrease in liver injury (necrosis and inflammation) in both studied times. CONCLUSION These results suggest that vitamin E was able to protect the liver from lesions caused by thioacetamide.

scholarly journals An Unusual Case of ACLF : First Report from Bangladesh

2014 ◽  
Vol 14 (2) ◽  
pp. 192-194
Author(s):  
Ayub Al Mamun ◽  
Mamun Al-Mahtab ◽  
Abu Saleh Mohammad Sadequl Islam ◽  
Mohammad Forhad Abedin ◽  
Dulal Chandra Saha ◽  
...  
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Autoimmune Hepatitis ◽  
Unusual Case ◽  
Chronic Liver ◽  
Disease Entity ◽  
Chronic Liver Failure ◽  
B Virus ◽  
History Of ◽  
Cirrhosis Of Liver

Autoimmune hepatitis is often unrecognized and under-diagnosed, especially in our part. Acute on chronic liver failure (ACLF) on the other hand is a newly recognized disease entity describing patients who develop acute liver failure on the background of pre-existing chronic liver disease. Methods: We present an elderly lady who presented to us with history of episodic fever and jaundice over a period of two years. Results: Although initially diagnosed as a case of idiopathic thrombocytopenic pupura (ITP), on further investigation she was finally diagnosed as ACLF (hepatitis B virus induced acute liver failure on autoimmune hepatitis induced cirrhosis of liver).DOI: http://dx.doi.org/10.3329/jom.v14i2.19674 J Medicine 2013, 14(2): 192-194

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