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Extensive haemorrhagic necrosis of liver is an unpredictable fatal complication in dengue infection: a postmortem study.

Kularatne SA, Imbulpitiya IV, Abeysekera RA, Waduge RN, Rajapakse RP, Weerakoon KG - BMC Infect. Dis. (2014)

Bottom Line: Histology of the liver revealed massive necrosis with haemorrhages in these patients with evidence of micro and macrovesicular steatosis with significant periportal inflammatory infiltrate.No significant ischaemic changes or necrosis was observed in the other organs.Predilection for severe liver disease remains unknown.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Unit, Teaching hospital, Peradeniya, Sri Lanka. rajithaasa55@gmail.com.

ABSTRACT

Background: Dengue infection carries a potential risk of death despite stringent management of plasma leak and haemorrhage. It appears that the extent of liver dysfunction determines the outcome.

Methods: We present a postmortem study of five patients, died of dengue shock syndrome who had markedly elevated liver enzymes and irreparable circulatory failure.

Results: All were females with a median age of 46 years (range 20-50 years). All had positive NS1 and IgM. Clinically, one patient developed severe degree of hepatic encephalopathy whilst three patients developed uncontrollable bleeding manifestations. Dengue virus was detected in three liver specimens by reverse transcription PCR. Histology of the liver revealed massive necrosis with haemorrhages in these patients with evidence of micro and macrovesicular steatosis with significant periportal inflammatory infiltrate. No significant ischaemic changes or necrosis was observed in the other organs.

Conclusions: Severe haemorrhagic necrosis of the liver was the cause of death in these patients probably due to direct viral infection. Predilection for severe liver disease remains unknown. Therefore, it is prudent to think beyond plasma leak as the main pathology of dengue infection and attempts should be made to develop other treatment modalities to prevent and manage unforeseen fatal complications of dengue infection.

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Related in: MedlinePlus

(Case 1) – H & E section of liver showing extensive haemorrhagic necrosis of liver parenchyma.
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Figure 1: (Case 1) – H & E section of liver showing extensive haemorrhagic necrosis of liver parenchyma.

Mentions: Macroscopic examination of multiple organs was done in four patients. Patient number 2 had only histology of core biopsy of liver, kidney and heart. Macroscopically all other cases had enlarged and congested liver. Two specimens revealed subcapsular haemorrhages with multiple petechiae on the surface of the liver. All patients showed evidence of fluid leakage with pleural effusions and ascites with one patient additionally having a significant pericardial effusion. None of the organs showed macroscopic evidence of ischaemic changes or evidence of necrosis.


Extensive haemorrhagic necrosis of liver is an unpredictable fatal complication in dengue infection: a postmortem study.

Kularatne SA, Imbulpitiya IV, Abeysekera RA, Waduge RN, Rajapakse RP, Weerakoon KG - BMC Infect. Dis. (2014)

(Case 1) – H & E section of liver showing extensive haemorrhagic necrosis of liver parenchyma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4008311&req=5

Figure 1: (Case 1) – H & E section of liver showing extensive haemorrhagic necrosis of liver parenchyma.
Mentions: Macroscopic examination of multiple organs was done in four patients. Patient number 2 had only histology of core biopsy of liver, kidney and heart. Macroscopically all other cases had enlarged and congested liver. Two specimens revealed subcapsular haemorrhages with multiple petechiae on the surface of the liver. All patients showed evidence of fluid leakage with pleural effusions and ascites with one patient additionally having a significant pericardial effusion. None of the organs showed macroscopic evidence of ischaemic changes or evidence of necrosis.

Bottom Line: Histology of the liver revealed massive necrosis with haemorrhages in these patients with evidence of micro and macrovesicular steatosis with significant periportal inflammatory infiltrate.No significant ischaemic changes or necrosis was observed in the other organs.Predilection for severe liver disease remains unknown.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Unit, Teaching hospital, Peradeniya, Sri Lanka. rajithaasa55@gmail.com.

ABSTRACT

Background: Dengue infection carries a potential risk of death despite stringent management of plasma leak and haemorrhage. It appears that the extent of liver dysfunction determines the outcome.

Methods: We present a postmortem study of five patients, died of dengue shock syndrome who had markedly elevated liver enzymes and irreparable circulatory failure.

Results: All were females with a median age of 46 years (range 20-50 years). All had positive NS1 and IgM. Clinically, one patient developed severe degree of hepatic encephalopathy whilst three patients developed uncontrollable bleeding manifestations. Dengue virus was detected in three liver specimens by reverse transcription PCR. Histology of the liver revealed massive necrosis with haemorrhages in these patients with evidence of micro and macrovesicular steatosis with significant periportal inflammatory infiltrate. No significant ischaemic changes or necrosis was observed in the other organs.

Conclusions: Severe haemorrhagic necrosis of the liver was the cause of death in these patients probably due to direct viral infection. Predilection for severe liver disease remains unknown. Therefore, it is prudent to think beyond plasma leak as the main pathology of dengue infection and attempts should be made to develop other treatment modalities to prevent and manage unforeseen fatal complications of dengue infection.

Show MeSH
Related in: MedlinePlus