Rapid initiation of standard-volume plasma exchange for acute liver failure from dengue infection

The incidence of dengue fever (DF) is rapidly rising and acute liver failure (ALF) is a rare but life-threatening associated complication. We present an adult patient who underwent standard-volume plasma exchange (PLEX) promptly after diagnosis of DF-associated ALF. PLEX of 1.5 times plasma volume was started on the same day of ALF diagnosis with the replacement fluid comprising 2.0 L of fresh frozen plasma and 1.0 L of 5% albumin. The patient's hepatic encephalopathy resolved the following day, and his biochemical profile significantly improved without additional cycles of PLEX and he was discharged well. This case report describes the rapid initiation of PLEX within hours of hepatic encephalopathy onset, using a single cycle of standard-volume PLEX alone without the influence of other therapeutic confounders. This case contributes to the evolving literature on the optimal timing and volume of PLEX in DF-ALF.