When dengue disguises itself: Uncommon presentation resembling hemophagocytic lymphohistiocytosis in a young adult

Title : When dengue disguises itself: Uncommon presentation resembling hemophagocytic lymphohistiocytosis in a young adult

Abstract:

We describe a case of a 24-year-old male who presented with fever associated with flu-like symptoms that progressed to skin involvement with a diffuse erythematous and painful rash necessitating inpatient admission for further management. His physical examination was notable for widespread maculopapular rash of the trunk, upper and lower extremities as well as splenomegaly. Extensive investigations were remarkable for elevated liver function tests, ferritin, lactate dehydrogenase, and a peripheral smear revealing ovalocytes with reactive lymphocytes. Brucella antibodies but dengue and cytomegalovirus antibodies were still pending during his inpatient stay. Other autoimmune and infectious investigations and imaging were negative.  Multidisciplinary discussions between Rheumatology, Dermatology, and Haematology resulted in primary differentials of hemophagocytic lymphohistiocytosis (HLH), drug eruption rash, and viral illness. He was started on methylprednisolone 80 mg, followed by a gradual taper in light of the differentials. A bone marrow biopsy was scheduled but patient’s family declined and he was discharged home. Upon follow-up two weeks post-discharge, the patient received a diagnosis of dengue fever based on the identification of elevated IgM and IgG levels in the initial laboratory tests conducted during the inpatient admission.

Biography:

Reem Alblooshi, MD is an Internal medicine doctor who graduated from Internal Medicine Residency program at Cleveland Clinic Abu Dhabi institution. She qualified from RAK Medical Health Science University. She then completed her internship at Cleveland Clinic Abu Dhabi. She joined the same center for Internal Medicine residency program. She worked as a junior internal medicine resident then senior resident. Her academic career includes a number of publications in peer reviewed journals. She was an active member of the medical education community. She is a member of American college of physician for internal medicine. She navigated the rigorous training, showcasing exceptional diagnostic acumen and empathy. Her journey is marked by tireless nights, hands-on experience, and a commitment to staying at the forefront of medical advancements.