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Dengue Infection Presenting as Acute Liver Failure

KAPIL DEV JAMWAL

Abstract


Dengue Infection Presenting as Acute
Liver FailureKAPIL DEV JAMWAL, SAJITH
KG, GOEL A, UDAY Z, JEYAMANI
R AND EAPEN CE.DEPARTMENT OF
HEPATOLOGY, CHRISTIAN MEDICAL
COLLEGE, VELLORE.Background Dengue
infection is transmitted by Aedes and
is endemic in certain regions of the
world. The clinical manifestations of dengue
infection may manifest from a clinically
asymptomatic state to dengue
shock syndrome and death. Dengue infections
and its outcomes are regarded
as poor when it involves multiple systems
simultaneously especially involving
Liver and central nervous system. Although
liver involvement is atypical, but
cases and case series have been reported
in the literature.Case Report A 16
year old boy from Andhra Pradesh presented
with fever for 3 days and jaundice
with altered sensorium of two days duration.
On admission he was conscious but
disoriented with Grade II hepatic encephalopathy.
His vitals were stable. He
had icterus and skin exam was normal.
His CNS examination was unremarkable
including a fundoscopic examination.
His per abdomen examination was normal
with a normal liver span.His baseline investigations
showed Complete hemogram Hb
of 17 gm, PCV (hematocrit) of 53 and
platelet count of 23,000mm3. His urea 44
and creatinine was 1.3 respectively (441.3
mgdl). His PTINR was 19.21.7 (control
10.2-12.41.1) and aPTT was 86.6(control
upto 34). His liver functions - Total Bilirubin
15 Direct Bilirubin 12 Protein 6.3 Albumin
3.0 AST 1445 ALT 1654 SAP 195)The
CECT brain was normal and an USG abdomen
was also normal.During the subsequent
days in hospital, his sensorium worsened
and he developed epistaxis. A repeat
platelet count was done and it was
7,000mm3. His LFT showed ASTALT
98653148 IUml and serum LDH and Serum
fibrinogen were 10962 IUml and 59.7 mgdl
respectively.His serum IgM HAV, IgM HEV
and leptospira serology were negative. His
dengue serology was positive.Conclusion
Dengue infection can present as acute liver
failure. The management is supportive and
the recovery is uneventful usually.


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References


Jelinek T: Dengue fever in international

travelers. Clin Infect Dis 2000, 31(1):144-7.

Parkash et al. BMC Gastroenterology

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