Dengue and Chikungunya Co-Infection-Associated Multi-Organ Dysfunction Syndrome: A Case Report

Abstract

Dengue and chikungunya infections are increasing globally, especially in India. While the majority of patients settle with symptomatic management, some develop life-threatening complications. Here we discuss a case of co-infection between dengue virus (DENV-2) and chikungunya virus (CHIKV) in a young Indian male who presented with an acute febrile illness that progressed to multi-organ dysfunction involving the hepatic, nervous, respiratory, and hematological systems. We discuss the management of this complicated case and attempt to generate awareness regarding the severity of co-infection by these viruses.

Keywords: chikungunya; co-infection; dengue; dengue fever (df); dengue hemorrhagic fever (dhf); diffuse alveolar hemorrhage; encephalitis; hepatitis; multi-organ dysfunction; thrombocytopenia.

Figure 1. MRI brain of the patient showing encephalitis changes

An area of altered signal intensity noted in the splenium of the corpus callosum (shown by red arrow), appearing hyperintense on T2-weighted image sequence (A), showing diffusion restriction on diffusion-weighted imaging sequence (B) with corresponding low apparent diffusion coefficient value (C).

Figure 2. Petechiae can be seen on the patient's trunk (A) and left arm (B) shown by white arrow

Figure 3. Chest x-ray radiographs from day 1 to day 10

(A) Day 1: No obvious abnormality; (B) Day 4: Multiple new bilateral opacities; (C) Day 6: Bilateral opacities resolving; (D) Day 10: Resolution of opacities

Figure 4. Suction collection tube of the patient containing blood tinged secretions

Figure 5. Timeline of events from OPD visit to discharge

OPD: Out-Patient Department; IPD: In-Patient Department; GTCS: Generalized Tonic Clonic Seizure; ICU: Intensive Care Unit; DAH: Diffuse Alveolar Hemorrhage; S.D.P: Single Donor Platelets; F.F.P: Fresh Frozen Plasma; PRBC: Packed Red Blood Cells; PEEP: Positive End Expiratory Pressure