A rare case of acute liver failure with intrahepatic cholestasis due to dengue hemorrhagic fever: CytoSorb® and plasma exchange aided in the recovery: case report

BMC Infectious Diseases

Case Report

Ranjith Kalupahana¹  Udeshan Eranthaka¹  Dilshan Priyankara¹  Arosha Minori Gunasekera¹ 

[1] National Hospital of Sri Lanka, Colombo, Sri Lanka;

关键词: Cholestasis;    Acute liver failure;    Dengue fever;    Dengue haemorrhagic fever;    Therapeutic plasma exchange;    Cytosorb®;   

DOI  :  10.1186/s12879-022-07933-y

 received in 2022-08-07, accepted in 2022-12-06,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundDengue haemorrhagic fever is a severe form of acute dengue infection characterized by leakage of plasma through capillaries into body spaces resulting in circulatory insufficiency leading to shock. Despite varying degrees of liver involvement occurring in acute dengue infection, intrahepatic cholestasis is very rare in the literature with only two cases reported so far. We report a challenging case of a middle-aged woman with DHF complicated by acute liver failure, coagulopathy, acute renal failure and prolonged intrahepatic cholestasis. She was successfully managed in the intensive care unit with supportive therapy, Cytosorb® and therapeutic plasma exchange.Case presentationA 54-year-old Sri Lankan obese woman with multiple comorbidities presented with fever, headache, vomiting and generalized malaise for 3 days and was diagnosed with dengue haemorrhagic fever. Despite the standard dengue management, she clinically deteriorated due to development of complications such as, acute liver injury, intrahepatic cholestasis and acute renal injury. Acute liver failure was evidenced by transaminitis, lactic acidosis, coagulopathy with pervaginal bleeding and severe encephalopathy necessitating elective intubation and mechanical ventilation. She was immediately transferred to intensive care facilities where she underwent supportive management for liver failure, continuous renal replacement therapy coupled with cytosorb and therapeutic plasma exchange with which she made a remarkable recovery.ConclusionAcute liver failure with a prolonged phase of intrahepatic cholestasis is a very rare complication of acute dengue illness which is sparsely documented in medical literature so far. This patient was managed successfully with supportive therapy, aided by cytoSorb hemo-adsorption and therapeutic plasma exchange.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

Fig. 2