Abstract
Introduction
Dengue fever is a common viral infection in tropical regions, including Cambodia. While rare, it can lead to severe aplastic anemia (AA), a life-threatening condition marked by bone marrow failure and pancytopenia, posing significant diagnostic and therapeutic challenges. Early recognition and treatment are crucial for improving outcomes. This case report presents a unique instance of dengue-induced very severe AA that was successfully managed with immunosuppressive therapy.
Case Presentation
An 11-year-old Cambodian boy presented with fever, headache, myalgia, vomiting, and mild abdominal pain. Laboratory tests revealed pancytopenia, with a WBC count of 0.9 × 10⁹/L, an absolute neutrophil count (ANC) of 0.5 × 10⁹/L, an Hb concentration of 7.3 g/dL, and a platelet count of 70 × 10⁹/L. Dengue serology was positive for both IgG and IgM, confirming the presence of dengue fever. After 16 days, the patient was afebrile for more than 9 days, but persistent pancytopenia led to a referral for haematology. Repeated laboratory investigations confirmed severe pancytopenia, with a white blood cell count (WBC) of 0.9 × 10⁹/L, an ANC of 0.08 × 10⁹/L, a hemoglobin (Hb) concentration of 7.7 g/dL, a platelet count of 40 × 10⁹/L, and an absolute reticulocyte count of 2.94 × 10⁹/L, with a bone marrow exam revealing very severe aplastic anemia (AA) secondary to dengue. Biimmunosuppressive therapy with cyclosporin A (8 mg/kg/day) and prednisolone (2 mg/kg/day) was started. The patient improved significantly, with normalization of blood counts and resolution of hemorrhagic symptoms, and was discharged. Cyclosporine treatment was continued for 3 months, resulting in complete remission.
Conclusion
Aplastic anemia secondary to dengue fever is an uncommon but serious complication. Early recognition, particularly in endemic areas, and timely initiation of immunosuppressive therapy are crucial for favorable outcomes. In resource-limited settings where ATG is not accessible, such as in Cambodia, a combination of cyclosporin A and corticosteroids can be an effective alternative, as demonstrated in this case.