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Primary dengue infection triggered haemophagocytic lymphohistiocytosis in a neonate
  1. Gopal Agrawal1,
  2. Sanjay Wazir1,
  3. Anupam Sachdeva2 and
  4. Surender Kumar1
  1. 1Department of Neonatology, Cloudnine Hospital, Gurgaon, India
  2. 2Institute of Child Health, Pediatric Hematology Oncology Unit, New Delhi, India
  1. Correspondence to Dr Gopal Agrawal; drgopalagrawal2000{at}


Haemophagocytic lymphohistiocytosis (HLH) is an aggressive syndrome which has characteristic symptoms and laboratory findings. Infection is a common trigger of HLH. We report a 2700 g male infant with persistent fever, massive hepatosplenomegaly and severe thrombocytopaenia. Laboratory evidence of primary dengue infection was detected. Investigations revealed hypertriglyceridaemia, hypofibrinogenaemia, hyperferritinaemia and elevated soluble CD25. Bone marrow examination revealed haemophagocytes. The diagnostic criteria for HLH were fulfilled. A diagnosis of secondary HLH triggered by primary dengue infection was considered. Dexamethasone was initiated and continued for 8 weeks. He responded clinically with regression of hepatosplenomegaly, was afebrile and platelet counts normalised. Dengue‐associated HLH is often missed clinically as treating physicians focus more on the underlying infection and its treatment. In neonates, HLH should be considered as differential diagnosis of sepsis and other viral infections, particularly in situations of inappropriate response to standard management.

  • haematology (incl blood transfusion)
  • tropical medicine (infectious disease)
  • neonatal intensive care
  • malignant and benign haematology
  • infant health

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  • Contributors GA: conceived and wrote the manuscript. SW and AS: critically reviewed and finalised the manuscript. GA, SW, AS and SK were involved in clinical care of the infant, read and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.