104 J Med Assoc Thai Vol. 91 No. 1 2008 Hemophagocytic Syndrome in Dengue Hemorrhagic Fever with Severe Multiorgan Complications Tanomsri Srichaikul MD*, Sompone Punyagupta MD*, Termkiat Kanchanapoom MD*, Chow Chanokovat MD *, Kanchit Likittanasombat MD**, Apichai Leelasiri MD*** * Department of Medicine, Vichaiyut Hospital, Bangkok ** Department of Medicine, Ramathibodhi Hospital, Bangkok *** Department of Medicine, Pramongkutklao Hospital, Bangkok A 46 year old woman who presented with severe multiorgans involvement including liver, brain, cardio-pulmonary failure, gastrointestinal bleeding, progressive cytopenia, DIC and hemophagocytic syn- drome during the convalescent phase of Dengue type II has been successfully treated primarily with pulse methyl prednisolone and high dose intravenous immunoglobulin G. The authors believe that HPCS are not infrequently seen with high mortality and recommended early diagnosis and treatment with the regimen. This is the first complete report of hemophagocytic syndrome in adult dengue hemorrhagic fever in Thailand. The literature of HPCS in DHF was reviewed and discussed. Keywords: Hemophagocytic syndrome, Dengue hemorrhagic fever, Severe multiorgan complications Correspondence to : Srichaikul T, Department of Medicine, Vichaiyut Hospital, Bangkok 10400, Thailand. Phone: 0-2616- 9607, 089-495-4214 In recent studies on dengue hemorrhagic fever (1-5) various severe complications with high fatality namely encephalopathy, severe hepatic failure, disseminated intravascular coagulation and multiple organs failure have been reported which are unusual in the previous studies. The authors reported here an adult Thai female who survived the severe multiorgan involvement with definite evidence of hemophagocytic syndrome (HPCS) by the treatment with pulse methyl prednisolone and high dose intravenous immuno- globulin G. Case Report A 46-year old Thai female patient (HN 337110) was transferred to Vichaiyut Hospital in Bangkok on October 4, 2006 with the history of high fever, nausea and vomiting 4 days previously. She was immediately admitted to another hospital on the first day of disease and intravenous antibiotics were given and the fever seemed to be better yet nausea and abdominal dis- comfort persisted. She then asked to be transferred to the presented hospital. On admission the temperature was 37.5 C and fever gradually came down to normal. Physical examination revealed no rash, no dyspnea, no edema, clear lungs, no hepatosplenomegaly nor lymphadenopathy. CBC revealed Hct 31.6%, Wbc 5,200/ mm 3 , 51% PMN with 39% band form, 10% lymphocyte and 87,000/mm 3 platelets, Blood chemistry revealed elevated transaminasemia (SGOT 151 units/Lt, SGPT 95 units/Lt), albumin 3.1 gm%, LDH 2004 units/Lt. The clinical diagnosis of dengue fever was made and Dengue Virus (NS 1 Ag) was positive. She asked to be discharged on October 6 because “she felt better”. On the first day after the discharge, she had diarrhea 4 times with black colored stools associated with severe headache and dyspnea on exertion. She, therefore, was readmitted to the hospital on October 7, 2007. Physical Examination on the 2 nd admission revealed temperature of 37.6 C, blood pressure 130/80 mmHg, pulse 50 per minute with extra beats. Edema of both legs, jaundice, dyspnea and petechial spots at J Med Assoc Thai 2008; 91 (1): 104-9 Full text. e-Journal: http://www.medassocthai.org/journal Case Report