Severe nonfebrile dengue infection in an adolescent after postoperative kidney transplantation: a case report.

Authors:
Address: Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. raktn@mahidol.ac.th
Journal:

Publication:

abstract

We herein have reported a case of Severe nonfebrile dengue infection complicated with refractory pancytopenia and a large perinephric hematoma with shock in a 16-year-old adolescent during the early postoperative period after kidney transplantation. After the diagnosis of end-stage renal disease she underwent living-related kidney transplantation. Thirteen days after successful transplantation, she exhibited a notable amount of ascites, bilateral pleural effusions, thrombocytopenia, and increased hemoglobin without pre-existent fever. Further investigation revealed positive dengue nonstructural protein 1 antigen (dengue NS1 Ag) and dengue virus serotype 1 by a reverse transcriptase-polymerase chain reaction (RT-PCR) in the patient's serum. She exhibited hemophagocytic syndrome, manifested by refractory pancytopenia and refractory anemia resulting in hypovolemic shock and acute graft failure on day 28 posttransplantation. The anemia was attributed to a large hematoma around the transplanted kidney requiring surgical evacuation of clotted blood. Postoperatively, she gradually recovered with resolution of thrombocytopenia and excellent graft function. Persistent dengue antigenemia and viremia was shown by dengue NS1 Ag and RT-PCR of dengue serotype-1. The viremia was present longer than the dengue antigenemia. Dengue-specific immunoglobulin M (IgM) and IgG by enzyme-linked immunosorbent assay confirmed the primary dengue infection and evidence of a recent donor dengue infection.

Related Articles
Evaluation of a commercial SD dengue virus NS1 antigen capture enzyme-linked immunosorbent assay kit for early diagnosis of dengue virus infection.
J Clin Microbiol. 2010
Evaluation of a commercial SD dengue virus NS1 antigen capture enzyme-linked immunosorbent assay kit for early diagnosis of dengue virus infection.
Wang SM, Sekaran SD. J Clin Microbiol. 2010 Aug; 48(8):2793-7. Epub 2010 Jun 23.
Enzyme-linked immunosorbent assay specific to Dengue virus type 1 nonstructural protein NS1 reveals circulation of the antigen in the blood during the acute phase of disease in patients experiencing primary or secondary infections.
J Clin Microbiol. 2002
Enzyme-linked immunosorbent assay specific to Dengue virus type 1 nonstructural protein NS1 reveals circulation of the antigen in the blood during the acute phase of disease in patients experiencing primary or secondary infections.
Alcon S, Talarmin A, Debruyne M, Falconar A, Deubel V, Flamand M. J Clin Microbiol. 2002 Feb; 40(2):376-81.
Clinical and virological factors influencing the performance of a NS1 antigen-capture assay and potential use as a marker of dengue disease severity.
PLoS Negl Trop Dis. 2011
Clinical and virological factors influencing the performance of a NS1 antigen-capture assay and potential use as a marker of dengue disease severity.
Duong V, Ly S, Lorn Try P, Tuiskunen A, Ong S, Chroeung N, Lundkvist A, Leparc-Goffart I, Deubel V, Vong S, et al. PLoS Negl Trop Dis. 2011 Jul; 5(7):e1244. Epub 2011 Jul 19.
Review [Human herpes virus 6 infection in renal transplant recipient--case report].
Przegl Epidemiol. 2006
Review [Human herpes virus 6 infection in renal transplant recipient--case report].
Deborska-Materkowska D, Sadowska A, Matłosz B, Zegarska J, Durlik M. Przegl Epidemiol. 2006; 60(1):141-6.
Review Laboratory diagnosis of dengue virus infection: current and future perspectives in clinical diagnosis and public health.
J Microbiol Immunol Infect. 2005
Review Laboratory diagnosis of dengue virus infection: current and future perspectives in clinical diagnosis and public health.
Kao CL, King CC, Chao DY, Wu HL, Chang GJ. J Microbiol Immunol Infect. 2005 Feb; 38(1):5-16.

To top • Home

TraveldoctorOnline 2001 • Disclaimer • webmaster

The contents within traveldoctoronline are presented only for informational purposes and cannot substitute for professional health care or any other medical treatment.All users of this website with health problems should be oblige always to consult their medical doctor before starting any treatment.