Bengaluru: 5-year-old emerges triumphant over Dengue induced HLH: A story of resilience in the face of rare complications

Lately, Bengaluru has seen a surge in Dengue cases which has become a major health concern. In its mild form, Dengue is generally associated with a self-limiting course and does not always require hospitalization. However, hospitalization is recommended for severe cases. Rarely there are instances of Dengue progressing to a life-threatening condition. Manipal Hospital Yeshwanthpur recently witnessed one such rare exception, underscoring the minimal likelihood of Dengue progressing into the formidable and rarely-seen complexities of Hemophagocytic Lymphohistiocytosis (HLH).

Recently, Mohammed, a five-year-old child, was referred to Manipal Hospital Yeshwanthpur with persistent high-grade fever and a concerning decline of cognitive functions. The child failed to recognize his parents, preferred sleep over meals, and was visibly pale with cold peripherals. Sensing the severity of Mohammed’s case, Dr. Nanditha Rathinam, Consultant Paediatrics and Paediatrics Intensive Care, Manipal Hospital, Yeshwanthpur, quickly admitted the child to the ICU. It became evident that severe Dengue had triggered acute liver failure, subsequently impacting his brain function.

In the ICU, Dr. Nanditha Rathinam and the team noticed that Mohammed’s fever persisted at an alarming rate, and his liver failure progressed rapidly. He also had encephalopathy (inflammation of the brain) due to the failing liver. All these signs were an indication that the child’s Dengue had progressed in an unconventional course and was now seemingly life-threatening. To understand the cause of this unfortunate turn of events, the medical team examined his ferritin levels – a crucial indicator. A normal range hovers around 500, but Mohammed’s levels were extremely high at almost close to one lakh, intensifying concerns about his survival. Mohammed was diagnosed with Dengue-induced Hemophagocytic Lymphohistiocytosis (HLH).

Sharing valuable insights on the medical condition, Dr. Nanditha Rathinam said, “HLH, or Hemophagocytic Lymphohistiocytosis, is a rare and complex syndrome where the immune system becomes overly active. This leads to specific symptoms like high grade fever, enlarged liver and spleen, and hypotension affecting all cell lines. HLH can be either inherited or acquired and diagnosis involves looking at a person’s symptoms and certain test results”.

Undeterred by the severity of Mohammed’s condition, Dr. Nanditha Rathinam and the team embarked on a comprehensive treatment strategy. Despite the odds, Mohammed responded positively to multi-organ support, including ventilation. After over a week, when Mohammed’s organ functions showed signs of improvement the ventilator and other external medical supports were withdrawn. However, he was under the expert supervision of Dr. Nanditha Rathinam. After about two weeks of intense days in the ICU Mohammed’s resilience triumphed. Gradually, organ support was reduced, and he emerged from this medical ordeal with remarkable strength. A month later, the little fighter, Mohammed is good to return to his normal life, while preparing to go to school next month. He stands as a testament to the unwavering dedication of the medical team and his indomitable spirit.

Speaking about the whole ordeal, Dr. Nanditha Rathinam said, “In the face of life-threatening severe dengue with secondary HLH, Mohammed, a mere five-year-old, struggling with encephalopathy and acute liver failure, had alarmingly high ferritin levels. He required ventilator and multi-organ support. Mohammed’s battle in the ICU spanned for almiost two intense weeks. Miraculously, his response to treatment exceeded expectations, leading to his discharge after two weeks. Today, Mohammed graces us with a big smile during follow-up—a heartwarming outcome in the often challenging landscape of dengue-induced multi-organ dysfunction in children.”