Dengue Fever Complicated by Acute Acalculous Cholecystitis and Hemophagocytic Lymphohistiocytosis Despite Negative...

To report a case of dengue fever complicated by acute acalculous cholecystitis (AAC) and hemophagocytic lymphohistiocytosis (HLH), despite initial negative polymerase chain reaction (PCR) results.

We describe the clinical course of a 40-year-old woman who returned from Indonesia with a persistent fever and rash. The diagnosis was established through clinical evaluation, serological testing, and abdominal imaging. The study conformed to the principles outlined in the Declaration of Helsinki.

Although the initial dengue PCR result was negative, subsequent NS1 and IgM antibody test results were positive. The patient developed severe complications, including AAC, characterized by gallbladder wall thickening, and HLH, indicated by marked fever, splenomegaly, hypofibrinogenemia, hyperferritinemia, and high soluble IL-2 receptor levels. Despite these symptoms, the patient was managed conservatively. Planned percutaneous transhepatic gallbladder aspiration was canceled because of spontaneous improvement observed on ultrasonography. The patient recovered fully without corticosteroid or platelet transfusions and was discharged on day 14.

Given the potential for false-negative PCR results during the acute phase of dengue, multimodal serological testing is essential. This case demonstrates that severe atypical complications, such as AAC and HLH, can be resolved with supportive care alone, avoiding invasive procedures, immunosuppressive therapy, and platelet transfusion.