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Dengue fever associated with severe reactive thrombocytosis and gangrene of the toes: a case report

Abstract number: p1072

Surrun  S.K., Kandiah  D.A.

Introduction: 

We present a patient with dengue fever associated with severe reactive thrombocytosis and gangrene of the toes; a condition that to our knowledge has not been described before.

Case report: 

A 45-year-old Chinese lady, without any previous significant medical history, was admitted with fever, chills, myalgia and skin rashes of a few days' duration. The clinical examination was unremarkable except for some petichaeal rashes on the legs and arms. The blood investigations revealed a mild thrombocytopaenia, the platelet count dropping from 263 × 109 to 135 × 109/l, and a positive paired dengue serology. During the hospital stay she developed severe pain and bluish discoloration of the middle three toes of both feet that progressed to patches of superficial gangrene. The platelet count increased to a maximum of 1299 × 109/l. The echocardiogram and the CT scan of the aorta were normal. The duplex scan of arteries of the legs was normal up to the distal ends of posterior tibialis and dorsalis pedis. The full auto-immune serology was negative and complement levels were normal. After clopidogrel and pentoxyphylline were started the skin lesions and the platelet count improved significantly.

Discussion: 

Progression from thrombocytopaenia to severe thrombocytosis in dengue fever is an uncommon event. Though many types of skin lesions are known to occur in dengue fever, gangrene has not been documented so far. In our case, the unusual association of thrombocytosis and gangrene of the toes forced us to exclude other differentials like embolic phenomena, atherosclerosis and immunological disorders. As the investigations were negative, the diagnosis of dengue fever associated with severe reactive thrombocytosis with gangrene of the toes was one of exclusion. Though the thrombocytosis and the clinical condition responded to clopidogrel and pentoxyphylline, spontaneous resolution could still have occurred.

Conclusion: 

Severe reactive thrombocytosis and gangrene of the toes are rare complications of dengue fever. These complications can occur even in mild cases of dengue fever. A repeat full blood count after an episode of dengue fever is thus of paramount importance.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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