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Fatal Massive Pulmonary Hemorrhage in Dengue Infection

Dissanayake Mudiyanselage Priyantha Udaya Kumara Ralapanawa, Kushalee Poornima Jayawickreme, Ekanayake Mudiyanselage Madhushanka Ekanayake, Thilak Jayalath and Duminda Herath

Background

Pulmonary hemorrhage is a very rare complication of dengue infection. This condition presenting with hemoptysis has been reported in 1.4% of dengue infections. However, major hemorrhage is unusual except when associated with profound or prolonged shock. In contrast although this case showed no features of plasma leakage, it resulted in massive pulmonary hemorrhage leading to death.

Case Presentation

A 17 year old previously healthy Sri Lankan, Sinhalese male presented with a 5 day history of fever. On admission he was ill looking and the hematocrit was 44.8%. He was treated in the High Dependency Unit with close monitoring and was started on normal saline 100 ml per hour and showed improved blood pressure and hematocrit value of 41.5% with the initial chest X-ray and ultrasound on abdomen showing no fluid leakage. But within a few hours he developed sudden onset of hemoptysis and respiratory distress, and an urgent chest X-ray taken showed a patchy right sided middle lobe opacity with no pleural effusion. Death occurred following failed resuscitation and the post mortem revealed massive pulmonary hemorrhage.

Conclusion

Pulmonary hemorrhage in dengue infection has rapid progression associated with high mortality. Thus, a high index of suspicion is needed for diagnosis.