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VOLUME 24 , ISSUE 2 ( February, 2020 ) > List of Articles


Case of Near Fatal Massive Intracerebral Bleed Secondary to Cerebral Venous Thrombosis in a Patient with Dengue and Refractory Thrombocytopenia

Megha Sharma, Ullas K Gopalakrishna

Keywords : Cerebral venous thrombosis, Dengue, Eltrombopag, Thrombocytopenia

Citation Information : Sharma M, Gopalakrishna UK. Case of Near Fatal Massive Intracerebral Bleed Secondary to Cerebral Venous Thrombosis in a Patient with Dengue and Refractory Thrombocytopenia. Indian J Crit Care Med 2020; 24 (2):138-140.

DOI: 10.5005/jp-journals-10071-23351

License: CC BY-NC 4.0

Published Online: 20-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


We present a case of dengue with refractory thrombocytopenia who developed cerebral venous thrombosis (CVT) with intraparenchymal hemorrhage warranting surgical decompression. Patient was concluded to have secondary immune thrombocytopenic purpura (ITP) which remained refractory to high dose steroids, IVIg therapy, but responded to thrombopoietin receptor (TPO-R) agonist, eltrombopag.

  1. da Costa PSG, Ribeiro GM, Soares Junior C, da Costa Campos L. Severe thrombotic events associated with dengue fever, Brazil. Am J Trop Med Hyg 2012;87(4):741–742. DOI: 10.4269/ajtmh.2012.11-0692.
  2. Vasanthi N. Unusual presentation of dengue fever-cerebral venous thrombosis. J Clin Diagn Res 2015;9(6):OD09–OD10. DOI: 10.7860/JCDR/2015/13132.6068.
  3. Tilara M, Shah AN, Negi S, Dadhania J. A case of cerebral venous thrombosis in the patient with dengue. Int J Sci Res Pub 2014;4(8):1–11.
  4. Lin C, Wan S, Cheng H, Lei H, Lin Y. Autoimmune pathogenesis in dengue virus infection. Viral Immunol 2006;19(2):127–132. DOI: 10.1089/vim.2006.19.127.
  5. Wills B, Oragui E, Stephens A, Daramola O, Dung N, Loan H, et al. Coagulation abnormalities in dengue hemorrhagic fever: serial investigations in 167 vietnamese children with dengue shock syndrome. Clin Infect Dis 2002;35(3):277–285. DOI: 10.1086/341410.
  6. Mitrakul C. Bleeding problem in dengue haemorrhagic fever: platelets and coagulation changes. Southeast Asian J Trop Med Public Health 1987;18(3):407–412.
  7. Srichaikul T, Nimmannitya S. Haematology in dengue and dengue haemorrhagic fever. Baillieres Best Pract Res Clin Haematol 2000;13(2):261–276. DOI: 10.1053/beha.2000.0073.
  8. Azin FRFG, Goncalves RP, Pitombeira MHDS, Lima DM, Branco IC. Dengue: profile of haematological and biochemical dynamics. Rev Bras Hematol Hemoter 2012;34(1):36–41. DOI: 10.5581/1516-8484.20120012.
  9. Nakao S, Lai CJ, Young NS. Dengue virus, a flavivirus, propagates in human bone marrow progenitors and hematopoietic cell lines. Blood 1989;74(4):1235–1240. DOI: 10.1182/blood.V74.4.1235.bloodjournal7441235.
  10. Hottz E, Oliveira M, Nunes P, Nogueira R, Valls-de-Souza R, Da Poian A, et al. Dengue induces platelet activation, mitochondrial dysfunction and cell death through mechanisms that involve DC-SIGN and caspases. J Thromb Haemost 2013;11(5):951–962. DOI: 10.1111/jth.12178.
  11. Funahara Y, Sumarmo, Wirawan R. Features of DIC in dengue hemorrhagic fever. Bibl Haematol 1983;49:201–211. DOI: 10.1159/000408460.
  12. Ron-Guerrero CS, Barrera-Chairez E, Ron-Magaña AL, Razón-Gutiérrez JE. Trombocitopenia persistente parecida a púrpura trombocitopénica inmune asociada al dengue hemorrágico: informe de tres casos. Rev Hematol Mex 2013;14(2):86–90.
  13. Ramírez-Fonseca T, Segarra-Torres A, Jaume-Anselmi F, Ramírez-Rivera J. Dengue fever: a rare cause of immune thrombocytopenia. Bol Asoc Med P R 2015;107(2):51–53.
  14. Shashidhara K. Effect of high dose of steroid on plateletcount in acute stage of dengue fever with thrombocytopenia. J Clin Diagn Res 2013;7(7):1397–1400. DOI: 10.7860/JCDR/2013/6135.3143.
  15. Kularatne S, Walathara C, Mahindawansa S, Wijesinghe S, Pathirage M, Kumarasiri P, et al. Efficacy of low dose dexamethasone in severe thrombocytopenia caused by dengue fever: a placebo controlled study. Postgrad Med J 2009;85(1008):525–529. DOI: 10.1136/pgmj.2008.078444.
  16. Kumar P. Intravenous immunoglobulin responsive persistent thrombocytopenia after dengue haemorrhagic fever. J Clin Diagn Res 2016;10(4):OD10–OD11. DOI: 10.7860/JCDR/2016/17770. 7605.
  17. Dimaano EM, Saito M, Honda S, Miranda EA, Alonzo MTG, Valerio MD, et al. Lack of efficacy of high-dose intravenous immunoglobulin treatment of severe thrombocytopenia in patients with secondary dengue virus infection. Am J Trop Med Hyg 2007;77(6):1135–1138. DOI: 10.4269/ajtmh.2007.77.1135.
  18. Erickson-Miller C, DeLorme E, Tian S, Hopson C, Stark K, Giampa L, et al. Discovery and characterization of a selective, nonpeptidyl thrombopoietin receptor agonist. Exp Hematol 2005;33(1):85–93. DOI: 10.1016/j.exphem.2004.09.006.
  19. Cheng G. Eltrombopag, a thrombopoietin-receptor agonist in the treatment of adult chronic immune thrombocytopenia: a review of the efficacy and safety profile. Ther Adv Hematol 2012;3(3):155–164. DOI: 10.1177/2040620712442525.
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