Published on December 13, 2023
Ahmedabad: A 34-year-old man was brought to a private hospital in the city
recently with rashes all over his body, severe breathlessness, high-grade fever,
and no urine production.
The experts diagnosed it as a condition identified as hemophagocytic
lympho-histiocytosis (HLH) syndrome — an aggressive syndrome of excessive
immune activation.
The experts said that it all started with a dengue infection for the youth.
Prevalence of HLH is 4 in 10 lakh population or rare. Its progression can result in
liver failure or multi-organ dysfunction that can lead to death.
Dr Manoj Singh, pulmonologist and critical care specialist with Zydus Hospitals,
said that the patient had a history of severe dengue. “About one and a half years
ago, he had overcome drug-resistant tuberculosis.
The high dose of medication had weakened his immune system.
Thus, when he got the dengue infection, it resulted in rapid progression of viruses
in the bloodstream. It soon led to dengue haemorrhagic fever (DHF),” he said.
DHF or dengue shock syndrome results in internal bleeding and rapid drop of
platelets, said experts. In this case, too, the patientʼs platelet levels dropped below
critical 50,000-mark and his kidneys stopped producing urine. Congested lungs
also required external oxygen support.
Dr Singh along with a team of doctors including nephrologist Dr Devang Patwari,
hematologist Dr Nidhi Jain and infectious diseases specialist Dr Ketan Patel
worked on the case and started dialysis. The ICU stay continued for two weeks as
doctors also started steroid and immunoglobulin treatment.
“Aer weeks, his lungs started to improve, followed by bone marrow, and
ultimately brain. He was taken o the ventilator as his kidney function improved
gradually. Jaundice that had developed due to the condition also got better. His
feeding tube was also removed and he started passing urine,” said Dr Singh.
The team members said that the patient was discharged recently with his
creatinine levels also at desirable levels, nullifying the need for a follow-up
dialysis.
They added that prolonged fevers should not be ignored, especially by those who
have existing medical conditions.
Parth Shastri Archive 