Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 12 , ISSUE 5 ( September-October, 2020 ) > List of Articles


Acute Liver Failure in Postpartum Period—A Rare Complication of Dengue Infection: A Case Report

Shilpa Sapre, Henil Upadhyay, Charmy Parikh

Citation Information : Sapre S, Upadhyay H, Parikh C. Acute Liver Failure in Postpartum Period—A Rare Complication of Dengue Infection: A Case Report. J South Asian Feder Obs Gynae 2020; 12 (5):317-319.

DOI: 10.5005/jp-journals-10006-1812

License: CC BY-NC 4.0

Published Online: 01-03-2021

Copyright Statement:  Copyright © 2020; The Author(s).


Aim: Successful management of acute liver failure in a case of dengue infection in postpartum patient by a multidisciplinary approach. Background: Dengue fever is a viral infection transmitted by the bite of Aedes aegypti mosquito. It is a major public health problem in developing countries like India. Symptomatology of dengue ranges from mild self-limiting illness to fulminant liver failure. Hepatic dysfunction is a known complication in dengue fever that ranges from mild to moderate elevation of serum transaminases to catastrophic fulminant liver failure. Acute liver failure is a rare complication of dengue infection with high mortality rate. Case description: We report here a case of 19-year-old female who was referred to our center for management of primary postpartum hemorrhage with acute febrile illness. Laboratory investigations revealed anemia, thrombocytopenia, and positive dengue NS1 antigen test. The patient was managed in the critical care unit for pulmonary edema, acute kidney injury, and deranged coagulation profile secondary to hepatic dysfunction. Postpartum hemorrhage was another challenge tackled conservatively. The spectrum of liver involvement varied from a modest rise in transaminases in the early phase and culminating finally in acute hepatic failure by the end of 2 weeks. Multiple blood and blood products were transfused during her 1 month stay in intensive care. There was no perinatal transmission. A multidisciplinary approach involving obstetricians, intensivists, and gastroenterologists resulted in successful recovery of the patient from acute liver failure. Conclusion: Clinicians should have a high index of suspicion for dengue fever in endemic areas in a case of acute febrile illness with/without the classical signs and symptoms of dengue fever. Pregnancy poses a special challenge for the obstetrician as delivery during this period can have devastating complications. A multidisciplinary approach with cautious fluid management is advisable in patients with severe dengue infection. Postpartum hemorrhage can be one of the life-threatening complications due to thrombocytopenia and deranged coagulation profile. Acute liver failure is a rare complication but can develop in patients with severe hepatitis. Clinical significance: Dengue infection in pregnancy can mimic other causes of thrombocytopenia like HELLP syndrome, megaloblastic anemia, and gestational thrombocytopenia; hence, a detailed evaluation is warranted in pregnant women presenting with acute febrile illness with thrombocytopenia. Liver involvement in dengue infection can have devastating consequences leading to severe hepatitis and acute liver failure.

  1. Dengue infection in India: a systematic review and meta-analysis. PLoS Negl Trop Dis 2018;12(7):e0006618. DOI: 10.1371/journal.pntd.0006618.
  2. A case report of dengue haemorrhagic fever during the peripartum period: challenges in management and a case of vertical dengue transmission. BMC Infect Dis 2018;18(1):427. DOI: 10.1186/s12879-018-3352-x.
  3. Pregnancy outcome in women with dengue infection in Northern India. Indian J Clin Pract 2014;24(11):1053–1056.
  4. Liver involvement associated with dengue infection in adults in Vietnam. Am J Trop Med Hyg 2010;83(4):774–780. DOI: 10.4269/ajtmh.2010.10-0090.
  5. Case report: postpartum hemorrhage associated with dengue with warning signs in a term pregnancy and delivery. F1000 Res 2015;4:1483. DOI: 10.12688/f1000research.7589.1.
  6. Dengue viral infections as a cause of encephalopathy. Indian J Med Microbiol 2007;25(2):143–145. DOI: 10.4103/0255-0857.32722.
  7. Incidence and clinical outcome of acute liver failure caused by dengue in a hospital for tropical diseases, Thailand. Am J Trop Med Hyg 2016;95(6):1338–1344. DOI: 10.4269/ajtmh.16-0374.
  8. Estimating the dengue burden in India. The Lancet Global Health 2019;7(8):e988–e989. DOI: 10.1016/S2214-109X(19)30249-9.
  9. Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. Geneva, Switzerland: World Health Organization; 2009.
  10. Pathogenesis of liver involvement during dengue viral infections. Trans R Soc Trop Med Hyg 2006;100(7):608–614. DOI: 10.1016/j.trstmh.2005.10.007.
  11. Acute liver failure. N Engl J Med 2013;369(26):2525–2534. DOI: 10.1056/NEJMra1208937.
  12. Fulminant liver failure secondary to haemorrhagic dengue in an international traveller. Liver Int 2007;27(8):1148–1151. DOI: 10.1111/j.1478-3231.2007.01543.x.
  13. Clinical profile of dengue infection at a teaching hospital in North India. The Journal of Infection in Developing Countries 2012;6(07):551–554. DOI: 10.3855/jidc.2010.
  14. Spectrum of maternofetal outcomes during dengue infection in pregnancy: an insight. Infect Dis Obstet Gynecol 2016;2016:5046091. DOI: 10.1155/2016/5046091.
  15. Role of N-acetylcysteine treatment in non-acetaminophen-induced acute liver failure: a prospective study. Saudi J Gastroenterol 2017;23(3):169–175.
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