CASE PRESENTATION: Our patient was a 46-year-old Sri Lakan man who presented to our institution two years after undergoing an ABO-compatible cadaveric
liver transplant. At presentation, he had typical symptoms of
dengue fever. He was taking
prednisolone 5mg daily and
tacrolimus 3mg twice daily as immunosuppression. Initial investigations showed
thrombocytopenia and
neutropenia that reached a nadir by day 7 of his illness. He had elevated liver
enzymes as well. The diagnosis was confirmed on the basis of NS1
antigen detection by
enzyme-linked
immunosorbent assay. His blood cultures and polymerase chain reaction tests for cytomegalovirus were negative. He made an uneventful recovery and was discharged by day 9 of his illness. However, normalization of liver function took nearly two weeks. In three previously reported Brazilian cases of
dengue after
liver transplantation, the patients presented with
dengue shock syndrome, in contrast to the relatively milder presentation of our patient. Because of the lack of case reports in the literature, it is difficult to ascertain the risk factors for
severe dengue infection in transplants, but
dengue fever reported in renal transplants sheds some light on them. High-dose
steroids increase the risk of
thrombocytopenia, whereas
tacrolimus has been reported to prolong the duration of symptoms. Otherwise,
dengue fever is a relatively mild illness in patients who have undergone
renal transplantation, and renal allograft survival has been reported to be 86% following
dengue fever.
CONCLUSION:
Dengue is a rarely reported
infection in patients who have undergone
transplantation. A high degree of suspicion is required for diagnosis.
Dengue NS1
antigen detection is a useful addition to the already existing methods of diagnosis.
Steroids and
tacrolimus have effects on the morbidity of the disease. Graft outcomes following the
infection has been excellent in all reported cases.