Hyperinflammatory syndrome: Two viruses, similar story

Abstract

Objective: In countries where the co-existence of both dengue fever and COVID-19 infection is predominant, it is often difficult to clinically distinguish between the two entities. The present study highlights the similarities and differences of these viral diseases through two cases.

Results: The first case was of a 38-year-old hypertensive and diabetic female, diagnosed with dengue hemorrhagic fever with leucopenia and thrombocytopenia (26000/mm³). HRCT chest revealed diffuse mosaic attenuation and small pleural effusion in both lower lobes. Elevation in D Dimer and deranged liver function test were noted. One- month follow-up revealed that she had persistent fever, fatigue, musculoskeletal and psychological symptoms. Her symptoms improved with hydroxychloroquine 400 mg/day and a tapering course of steroids.

The second case was of 57-year-old hypertensive male, who presented with resolved mild COVID infection, blanching rash over dorsal aspect of both hands with active synovitis around left wrist, elbow and right ankle, and severe painful restriction of the joints.  Positive COVID IgG, increased inflammatory parameters and raised ferritin were noted. The patient showed symptomatic improvement with gradual reduction in inflammatory parameters following tapering dose of steroids and hydroxychloroquine treatment.

Conclusion: Persistence of symptoms and increased inflammatory parameters were noted in both the cases post the viral clearance, suggesting a non-degenerative immune response, leading to collateral damage. The treating physicians should consider such a possibility and treatment with glucocorticoids in this scenario would be prudent.