Abstract
BACKGROUND: Dengue fever is a major public health problem in developing countries like India. Symptomatology of dengue ranges from mild self-limiting illness to fulminant liver failure. Hepatic dysfunction is a known complication in dengue fever that ranges from mild to moderate elevation of serum transaminases to catastrophic fulminant liver failure. Acute liver failure is a rare complication of dengue infection with a high mortality rate.
CASE DESCRIPTION: We report a case of 19-year-old female who was referred for management of primary postpartum haemorrhage with acute febrile illness. Laboratory investigations revealed anaemia, thrombocytopenia and positive dengue NS1 antigen test. Patient was managed in critical care unit for pulmonary oedema, acute kidney injury and deranged coagulation profile secondary to hepatic dysfunction. Postpartum hemorrhage was another challenge tackled conservatively. Spectrum of liver involvement varied from a modest rise in transaminases in the early phase and culminating finally in acute hepatic failure by the end of second week. Multiple blood and blood products were transfused during her one month admission in intensive care. There was no perinatal transmission. Multidisciplinary approach involving obstetricians, intensivist and gastroenterologist resulted in successful recovery of the patient from acute liver failure.
CONCLUSION: Clinicians should have a high index of suspicion for dengue fever in endemic areas in a case of Acute Febrile Illness with/without the classical signs and symptoms of dengue fever. Pregnancy poses a special challenge for the obstetrician as delivery during this period can have devastating complications. Multidisciplinary approach with cautious fluid management is advisable in patients with severe dengue infection. Acute liver failure is a rare complication but can develop in patients with severe hepatitis. Dengue infection in pregnancy can mimic other causes of thrombocytopenia like HELLP syndrome, megaloblastic anaemia and gestational thrombocytopenia hence a detailed evaluation is warranted in pregnant women presenting with acute febrile illness with thrombocytopenia.
