Severe Dengue with Hepatorenal Dysfunction

Abstract

We present the case of a 50-year-old male patient, previously healthy, residing in an endemic area, who presented with a febrile disease, headache, and myalgias. Following self-medication and persistence of symptoms, he presented to the emergency department with vomiting and abdominal pain and was admitted to hospital. On the sixth day of evolution, he developed jaundice, dark urine, progressive oliguria, gingival bleeding, anuria, and deterioration of the consciousness level, for which he was transferred to the intensive care unit. Laboratory studies showed marked elevation of transaminases (AST 1460 U/L, ALT 930 U/L), creatinine of 6.4 mg/dL, thrombocytopenia (35 × 10⁹/L), and coagulopathy. Dengue serology was positive (NS1 and IgM). Abdominal ultrasonography revealed hepatomegaly, perivesicular edema, and bilateral pleural effusion. Management included hemodynamic support (norepinephrine), controlled hydration, fresh frozen plasma, and renal replacement therapy (3 hemodialysis sessions). After 15 days, vasopressor and renal support were discontinued with progressive improvement of hepatic and renal function. He was discharged on day 21 with normal renal function and hepatic enzymes near normal. This case underscores the possibility of severe multi-organ involvement in dengue and the importance of early multidisciplinary intensive management.