7-year-old girl has 100 times higher liver enzymes due to severe dengue fever

Patient LHLV, (7 years old, residing in Ca Mau) started sick 7 days ago, with the first 4 days of continuous high fever, 39 – 40 degrees Celsius, taking antipyretic drugs reduced but then the fever returned.

On the 5th day, the patient still had a fever with a lot of vomiting, so he was taken to the district health center. The patient received intravenous fluids, liver enzymes were normal, but still had a fever. On the 7th day of the illness, the family took the patient to Children’s Hospital 1.

The patient’s history of hemolytic anemia – Thalassemia was followed up periodically at Children’s Hospital 1 and had had Dengue hemorrhagic fever in 2018.

The patient was admitted to the hospital in a state of lethargy, high fever, stable hemodynamics, but liver enzymes increased 10 times higher than normal, and hyperbilirubinemia.

After 12 hours of admission, the patient’s state of consciousness deteriorated, coma, jaundice, enlarged liver with liver enzymes continued to increase 100 times higher than normal. Decreased liver function, severe coagulopathy.

Immediately, the patient was intubated to help with breathing and transferred to the Intensive Care Unit – Anti-poison. The patient continued to receive respiratory support, fight cerebral edema, treat severe acute liver failure, continuous dialysis, blood transfusion and blood products to stabilize blood clotting function to avoid heavy bleeding.

At the same time, doctors conduct tests to look for the cause of liver damage such as Dengue hemorrhagic fever, infection, viral hepatitis, autoimmune hepatitis, drug poisoning and metabolic disease…

Despite aggressive treatment, the patient was still in a deep coma, the degree of liver damage still worsened, causing severe liver failure and coagulation disorders.

Doctors of the Department of Intensive Care – Anti-toxicity consulted and decided to exchange large volume plasma in combination with continuous dialysis for pediatric patients to replace liver function and stabilize blood clotting function.

The miracle happened when the liver damage stopped and liver function gradually improved. At the same time, the test results showed that the patient had dengue hemorrhagic fever causing severe acute liver failure.

After more than 1 week of intensive treatment, the patient’s condition improved, the doctors stopped dialysis and weaned off the ventilator. Currently, the patient is awake, eating and drinking, liver function has recovered and is transferred to the Dengue Department for further monitoring.

Through this case, the doctors recommend: Currently, Dengue hemorrhagic fever epidemic is increasing and there are many severe cases, the pediatric patient is not only hospitalized in a state of cardiovascular collapse but also has multi-organ failure, especially severe acute liver failure causing hepatic coma, severe bleeding can lead to death.

Therefore, parents must always be wary of Dengue hemorrhagic fever is in season. Pediatric patients with fever for 2-3 days or more must be examined at a medical facility for early detection of dengue fever and prompt treatment.