Spectrum of Hepatic Manifestation in Neonatal Dengue: A Case Report

Dengue is endemic in India, placing all pregnant women at risk, with the highest likelihood of vertical transmission in the third trimester. Perinatal dengue remains poorly understood, particularly its hepatic manifestations and management in preterm neonates. We report a preterm male neonate (30 + 6 weeks, 1.94 kg) born to a dengue-infected mother, presenting with fever on day 4. Vertically transmitted dengue was confirmed by positive IgM and NS1 antigen. The infant developed severe hepatitis (SGOT 2160 U/l, SGPT 358 U/l), refractory thrombocytopenia (nadir 21 000/cumm) and hyperferritinaemia (>100 000 ng/ml). The baby was successfully managed with intravenous N-acetylcysteine for dengue-associated hepatitis and methylprednisolone for refractory thrombocytopenia, resulting in dramatic clinical improvement. Subsequently, he developed prolonged cholestasis, and by day 36, ultrasound showed hepatic dystrophic calcifications as post-infective sequelae, highlighting the need for vigilance and prolonged follow-up.