Dengue-Associated Hemophagocytic Lymphohistiocytosis: A Diagnostic and Therapeutic Challenge

Dengue fever, a widespread arboviral infection, ranges in severity from mild febrile illness to life-threatening conditions such as dengue hemorrhagic fever and dengue shock syndrome. Rarely, dengue can precipitate hemophagocytic lymphohistiocytosis (HLH), a severe hyperinflammatory syndrome characterized by dysregulated macrophage and T-cell activation. We report a case of a 45-year-old female presenting with fever, hepatosplenomegaly, cytopenias, and hyperferritinemia, who was diagnosed with dengue-associated HLH. The diagnosis was established using clinical findings, elevated ferritin, cytopenias, splenomegaly, and hemophagocytosis in the bone marrow, fulfilling the HLH-2004 criteria. Early initiation of dexamethasone, along with supportive therapy, improved the patient’s clinical status. This case underscores the importance of increased clinical vigilance for HLH in dengue patients with rapid clinical deterioration. Early diagnosis and prompt immunomodulatory therapy can significantly improve outcomes. Further research is needed to better understand the pathophysiology, diagnostic challenges, and optimal treatment strategies for dengue-associated HLH.