Severe Dengue-Associated Hepatitis in an Adolescent Treated With Oral Acetylcysteine: A Case Report

Dengue infection may lead to liver involvement ranging from mild transaminase elevation to severe hepatitis and, rarely, acute liver failure. Management is mainly supportive, and no specific therapy exists. We report the case of a 13-year-old adolescent with dengue with warning signs who developed severe hepatitis (aspartate aminotransferase (AST) 2034 U/L, alanine transaminase (ALT) 532 U/L) and thrombocytopenia. Oral N-acetylcysteine (NAC) was initiated as adjuvant therapy. During hospitalisation, a reduction in aminotransferase levels, clinical improvement, and recovery of platelet count were observed. These changes occurred during the course of illness; however, this temporal association does not establish causality and may reflect the expected recovery phase of dengue infection. This case describes the use of NAC as an adjuvant therapy in severe dengue-associated hepatitis. Further studies are required to evaluate its potential role in this setting.