A Haemophilic Dengue Patient with Pleural Effusion and Earache

Abstract

About 2.5 billion people are living at a higher risk of dengue fever in hundreds of tropical and sub-tropical countries. Treatment of dengue fever is quite complicated and challenging because of the lack of effective treatment approaches. We herein report a rare case of a 25-year-old female with a past medical history of haemophilia A, suffering from dengue fever, pleural effusion, earache, myalgia, headache, and vomiting. Dengue was confirmed by the non-structural protein 1 (NS1) antigen and immunoglobulin M (IgM) antibody test. She had low blood pressure (80/60 mmHg), frequent vomiting, and low platelet count during hospitalization. Moreover, a genetic disorder like haemophilia with plasma leakage and earache made the patient's condition worse. However, by repeated platelet infusion, the platelet counts elevated and the patient was discharged from the hospital after nine days. Complete recovery was achieved after 27 days. This is a rare case of dengue; physicians should be aware of the severity of the disease and its management tactics. More discussion and research need to be carried out to develop an effective and optimized treatment and management options to reduce the mortality and morbidity due to dengue fever with a co-morbid disease.

Keywords: bangladesh; dengue fever; earache; haemophilia; plasma leakage; pleural effusion.

Figure 1. Automatic cell count during hospitalization on day two

Lymphopenia and leukocytopenia marked by the red arrow (top-right) BASO: Basophil; DIFF: Differential; FSC: Forward scatter; PLT: Platelet; RBC: Red blood cell; SFL: Side fluorescence; SSC: Side scatter; WBC: White blood cell

Figure 2. Ultrasonogram of the whole abdomen during hospitalization at day four

Mild hepatomegaly with fatty infiltration of the liver (top-left), splenomegaly (bottom-left), pleural effusion and abdominal ascites (top-left and top-right) marked by red arrows.

Figure 3. Automatic cell count during hospitalization at day six

Abnormal platelet distribution and thrombocytopenia marked by the red arrow (bottom-right). BASO: Basophil; DIFF: Differential; FSC: Forward scatter; PLT: Platelet; RBC: Red blood cell; SFL: Side fluorescence; SSC: Side scatter; WBC: White blood cell.