Dengue presenting as Acute Liver Failure ? A case report

Background: Dengue is the most common arboviral illness in humans. It is transmitted by mosquitoes of the genus Aedes, which are widely distributed in subtropical and tropical countries. The dengue virus has four related but antigenically distinct serotypes: DENV-1, DENV-2, DENV-3, and DENV-4. Many patients with dengue experience a prodrome of chills and facial flushing, which may last for 2-3 days. Other symptoms may include headache, retro-orbital pain, severe myalgias, nausea and vomiting, maculopapular or macular confluent rash over the thorax with islands of skin sparing, weakness, altered taste sensation, anorexia, sore throat, hemorrhagic manifestations (e.g. petechiae, bleeding gums, epistaxis and hematuria) and lymphadenopathy. The incubation period is 3-14 days. Criteria for the diagnosis of dengue hemorrhagic fever, according to the World Health Organization (WHO), are as follows: Fever, Hemorrhagic manifestations (e.g. hemoconcentration, thrombocytopenia, and positive tourniquet test), Circulatory failure, such as signs of vascular permeability (e.g. hypoproteinemia, effusions) and Hepatomegaly. Aim: To know the atypical manifestations of Dengue such as acute liver failure, seizures and encephalopathy. Material and methods: Study material obtained from Columbia Asia hospital Patiala along with all the records and detailed history of the patient. The study was carried out in Intensive Care Unit of the hospital where the patient was admitted. Observation and conclusion: In our case, patient presented with Dengue Hemorrhagic Fever. He developed acute liver failure which was considered to be due to dengue infection as antigen for the same was positive and other viral markers were negative. Acute liver failure manifested in the form of raised liver enzymes, coagulopathy, and encephalopathy. Dengue can lead to mild to moderate elevation of liver enzymes but complication of acute liver failure is rare.