PB0722 - Dengue Hemorrhagic Fever in an adult with Chronic Immune Thrombocytopenia: a case report

Background: Immune thrombocytopenia (ITP) is an autoimmune illness affecting the blood, characterized by thrombocytopenia and the potential for severe bleeding symptoms. Patient with chronic ITP may experience a substantial decrease in platelets and bleeding symptoms due to dengue infection.

Aims: To highlights the consideration of whether to treat or not for the ITP, including platelet transfusion in the condition of dengue infection.

Methods: We present a case report of a patient with chronic ITP with grade 1 dengue hemorrhagic fever (DHF).

Results: A 25-year-old woman with a well-established 5-year history of ITP presented with a high fever reaching 41°C, accompanied by headache, myalgia, nausea, multiple petechiae on extremities, and normal vital signs. Other physical examinations were unremarkable. A series of laboratory investigations revealed thrombocytopenia, leukopenia, and a positive non-structural protein 1 (NS1) test. The patient received crystalloid infusion and symptomatic drugs, and she was monitored throughout hospitalization, recovering after 8 days without complications.

Hemorrhagic symptoms in individuals with dengue infection can be vary in severity, ranging from moderate to severe. Immune thrombocytopenia is characterized by a specific condition of thrombocytopenia without a known cause, generally accompanied by the presence of IgG or IgM antibodies attached to platelets. Treating ITP usually involves starting with high-dose glucocorticoids. Additionally, intravenous immunoglobulins (IVIG) and platelet transfusion can be given in some cases. Currently, there is no definitive protocol for recommending platelet transfusion in ITP. However, it can be considered for adult dengue patients who have a platelet count < 10,000/mm3 without hemorrhagic manifestation, and to prevent critical hemorrhagic in ITP.

Conclusion(s): Our patient did not exhibit severe thrombocytopenia, so the treatment is directed toward fluid replacement with serial laboratory monitoring. Platelet transfusion may be considered in patients with severe thrombocytopenia in cases of ITP with dengue infection to prevent critical hemorrhagic.