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Dengue in the pediatric population: : A series of cases of hemophagocytic lymphohistiocytosis as a rare complication..
Andrés Roberto González Cabrera- Miryam Paola Troya Toro
- Ámbar Noemí Armijos Cevallos
- Diana Gabriela Alvarado Soto
- Robinson Rolando Ramírez Ruiz
- Joyce Katherine Andrade Velasquez
Published 2026-10-01
How to Cite
Copyright (c) 2026 Andrés Roberto González Cabrera, Miryam Paola Troya Toro, Ámbar Noemí Armijos Cevallos, Diana Gabriela Alvarado Soto, Robinson Rolando Ramírez Ruiz, Joyce Katherine Andrade Velasquez
This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
Background: Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome that can be triggered by dengue, an arbovirus infection prevalent in tropical and subtropical regions.
Aim: To describe the demographic, clinical, and laboratory characteristics and the management and complications of a series of pediatric patients diagnosed with dengue and HLH.
Patients and Methods: A descriptive case series study was performed including 9 pediatric patients diagnosed with both dengue and HLH who were treated at the Dr. Roberto Gilbert Hospital in Guayaquil, Ecuador, from January 2020 to June 2025.
Results: Most patients were male (66.7%), with an average age of 4.3 years. All had a fever and an enlarged spleen. Cytopenias were observed in multiple cell lines (anemia 55.6%, thrombocytopenia 88.9%, leukopenia 77.8%), universal hyperferritinemia (44.4% > 10,000 ng/mL), and hypofibrinogenemia (88.9%). Hemophagocytosis in the bone marrow was confirmed in 100% of the patients assessed (the test was performed in 66.7%). Dexamethasone was the most common treatment (100%). Common complications included pneumonia (55.6%), liver failure (44.4%), serous effusions (pleural 77.8%, pericardial 33.3%), and bleeding (77.8%).
Conclusions: Dengue-associated HLH in pediatric patients presents with a severe clinical and laboratory profile. It is crucial to maintain a high level of diagnostic suspicion to ensure prompt and effective management.