With rapid spread of dengue infection has emerged as a public health concern in the State, Pune has reported a case of severe manifestation of this infection.
Pranjali, a 22-year-old medical student, was diagnosed with dengue. Due to which she lost eyesight in of her one eye because of bleeding in her retina. Pranjali’s case is a rare manifestation of complications in dengue virus.
She showed many other symptoms which are not commonly seen dengue cases. She was behaving irrelevant. Her platelet count could not improve even after seven days of dedicated treatment and it went to as low as 6,000. She had blood spots all over her body and blood passed through her urine.
Doctors say that when the virus is spreading rapidly, it is only with high clinical suspicion that such complications of dengue virus can be treated.
In Pranjali’s case, the doctors diagnosed her with dengue fever associated with hemophagocytic lymphophistocytosis (HLH) syndrome. The HLH is a complication of dengue virus. Only handful of cases is reported in medical literature and its occurrence is more in children. It has a mortality rate of 58 per cent.
Dr Abhijit Lodha, a physician at Ruby Hall Clinic, who is treating Pranjali, said, “If the diagnosis is delayed, patient’s survival cannot be ensured. You should have high clinical suspicion to diagnose such cases.”
Unusual to the normal dengue cases, Ferritin, a blood cell protein that contains iron, became very high in her body. her white blood cells, red blood cells and platelets were going down and there was presence of dengue virus in patient’s bone marrow. Her blood became severely thin. Her kidney and liver were not functioning normally.
Doctors performed certain tests to confirm dengue fever associated with HLH syndrome. “Her platelet count was not improving. She had seizures and her blood became very thin. There was high inflammation sensation in her body which we confirmed through CRP test. Ferritin was very high in her body,” added Lodha.
“We gave her tapering doses of steroids for eight weeks. We diagnosed it when the case was still moderate and could be treated with steroids. Though it is complication of infection, the treatment is very simple, what is essential is high clinical suspicion,” added Lodha.
Pranjali was admitted in Ruby hall on May 17. She visited the hospital for second follow up in the last week and doctors have ascertained that the infection is cured now. Pranjali said, “I was feeling drowsy when I was admitted. There was severe headache, seizures and body pain. I am still taking treatment for my eye as there was bleeding in the retina. But I am back to my routine now and feeling good.”