Acute Liver Failure in Postpartum Period—A Rare Complication of Dengue Infection: A Case Report

JOURNAL TITLE: Journal of South Asian Federation of Obstetrics and Gynaecology

Author
1. Shilpa Sapre
2. Charmy Parikh
3. Henil Upadhyay
ISSN
0974-8938
DOI
10.5005/jp-journals-10006-1812
Volume
12
Issue
5
Publishing Year
2020
Pages
3
Author Affiliations
    1. Department of Obstetrics and Gynecology, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
    1. Department of Obstetrics and Gynecology, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
    1. Department of Obstetrics and Gynecology, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
  • Article keywords

    Abstract

    Aim: Successful management of acute liver failure in a case of dengue infection in postpartum patient by a multidisciplinary approach. Background: Dengue fever is a viral infection transmitted by the bite of Aedes aegypti mosquito. It is a major public health problem in developing countries like India. Symptomatology of dengue ranges from mild self-limiting illness to fulminant liver failure. Hepatic dysfunction is a known complication in dengue fever that ranges from mild to moderate elevation of serum transaminases to catastrophic fulminant liver failure. Acute liver failure is a rare complication of dengue infection with high mortality rate. Case description: We report here a case of 19-year-old female who was referred to our center for management of primary postpartum hemorrhage with acute febrile illness. Laboratory investigations revealed anemia, thrombocytopenia, and positive dengue NS1 antigen test. The patient was managed in the critical care unit for pulmonary edema, acute kidney injury, and deranged coagulation profile secondary to hepatic dysfunction. Postpartum hemorrhage was another challenge tackled conservatively. The spectrum of liver involvement varied from a modest rise in transaminases in the early phase and culminating finally in acute hepatic failure by the end of 2 weeks. Multiple blood and blood products were transfused during her 1 month stay in intensive care. There was no perinatal transmission. A multidisciplinary approach involving obstetricians, intensivists, and gastroenterologists resulted in successful recovery of the patient from acute liver failure. Conclusion: Clinicians should have a high index of suspicion for dengue fever in endemic areas in a case of acute febrile illness with/without the classical signs and symptoms of dengue fever. Pregnancy poses a special challenge for the obstetrician as delivery during this period can have devastating complications. A multidisciplinary approach with cautious fluid management is advisable in patients with severe dengue infection. Postpartum hemorrhage can be one of the life-threatening complications due to thrombocytopenia and deranged coagulation profile. Acute liver failure is a rare complication but can develop in patients with severe hepatitis. Clinical significance: Dengue infection in pregnancy can mimic other causes of thrombocytopenia like HELLP syndrome, megaloblastic anemia, and gestational thrombocytopenia; hence, a detailed evaluation is warranted in pregnant women presenting with acute febrile illness with thrombocytopenia. Liver involvement in dengue infection can have devastating consequences leading to severe hepatitis and acute liver failure.

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