ĐẶC ĐIỂM HỘI CHỨNG THỰC BÀO MÁU LIÊN QUAN SỐT XUẤT HUYẾT DENGUE Ở TRẺ EM

Abstract

Background: Hemophagocytic lymphohistiocytosis is a rare complication of dengue.

Objectives: To describe the epidemiological, clinical characteristics and treatment of dengue-associated hemophagocytic lymphohistiocytosis at Children’s Hospital 1. Results: Dengue-associated hemophagocytic lymphohistiocytosis accounted for only 0.3% of pediatric patients hospitalized with a diagnosis of dengue at Children’s Hospital 1 from Jan 2015 - Mar 2021. The median age of admission was 4 years (IQR: 2 - 7). The disease was more common in boys than girls and 31.8% of patients had a history of EBV or CMV infection. Persistent high fever, hepatomegaly and splenomegaly were common clinical features. Severe dengue accounted for 56.1%, of which dengue shock and severe organ failure accounted for 28.8% and 27.3%, respectively. Cytopenia affecting ≥ 2 of three lineages in the peripheral blood (86.4%), hyperferritinemia > 500 ng/ml (98.5%), hypertriglyceridemia (74.2%), hemophagocytosis on bone marrow aspiration were common features. In addition, increased LDH > 300 U/L, increased transaminases, hyperbilirubinemia, hypofibrinogenemia were also common manifestations of D-HLH. The disease progressed to complete recovery, leaving no sequelae. Treatment was mainly supportive, with or without corticosteroids and IVIG.

Conclusions: It is necessary to closely monitor dengue cases with persistent high fever, cytopenia affecting ≥ 2 of three lineages in the peripheral blood or with multi-organ failure to early diagnose HLH. The disease can progress to completely recovery and treatment is mainly supportive.