Haemophagocytic lymphohistiocytosis in pregnancy

Dengue infection is emerging as one of the most common tropical diseases globally. It manifests in varying severity from asymptomatic to the most severe forms of the disease, characterized by coagulopathy, increased vascular fragility, and permeability (dengue haemorrhagic fever) that may progress to hypovolaemic shock (dengue shock syndrome). For atypical manifestations, a new terminology known as expanded dengue syndrome (EDS) was introduced. Haemophagocytic lymphohistiocytosis (HLH), is considered a spectrum of EDS, which is a rare, potentially fatal hyperinflammatory condition. A case of a pregnant woman with dengue fever diagnosed as secondary HLH is reported here. It was successfully managed with intravenous dexamethasone and supportive care. A high index of suspicion is paramount in diagnosing HLH when a patient deteriorates even after giving appropriate care for dengue infection. Early recognition and prompt treatment with immuno-suppressive therapy can bring a successful response.