Dengue Infection Presenting as Acute Liver Failure

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.