Dengue virus associated hemophagocytic syndrome in children: a case report

Hemophagocytic Syndrome (HS) is a clinico-pathologic entity characterized by activation of T lymphocytes and macrophages. It may be diagnosed in association with malignant, genetic, or autoimmune diseases, but is most linked with Epstein-Barr virus. There are few reports of association between HS and Dengue in pediatrics. Dengue fever, caused by a flavivirus, is an important mosquito-transmitted disease. It can cause increased vascular permeability that leads to a bleeding diathesis or disseminated intravascular coagulation known as dengue hemorrhagic fever (DHF). We present the case of a 10 month-old-female who developed DHF and dengue shock syndrome, requiring admission to intensive care unit. She developed hemophagocytosis diagnosed by bone marrow aspiration and atypical skin changes that have not been previously described in association with dengue fever. This is an unusual case of dengue related hemophagocytic syndrome that adds to the limited pediatric cases reported in literature.