Immune Modulatory Therapy for Severe Dengue Hemorrhagic Fever in a Patient With Mitochondrial Complex I Deficiency: A Case Report.
Audra N Iness, Ameya S Walimbe, Emily R Strouphauer et al.
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Case in brief
A 16-year-old male with mitochondrial complex I deficiency due to a homozygous likely pathogenic NDUFV1 variant developed dengue hemorrhagic fever. He experienced rapidly progressive weakness and respiratory distress, followed by intracranial hemorrhage and seizures. Encephalitis, arachnoiditis, and myelitis further complicated the illness. Treatment with corticosteroids, intravenous immunoglobulin, and plasma exchange was followed by clinical improvement and partial recovery of functional status.
What made this case unusual
The case combined severe dengue hemorrhagic fever with multiple neurologic complications in a patient with an underlying mitochondrial disorder, requiring extensive immunomodulation.
Diagnostic / clinical pearl
In a patient with mitochondrial complex I deficiency and dengue hemorrhagic fever, rapidly progressive neurologic and respiratory deterioration may accompany intracranial hemorrhage, seizures, and inflammatory involvement of the central nervous system.
Why it matters
The case illustrates the complexity of managing severe dengue in the setting of an underlying mitochondrial disorder.