A 26 year old resident doctor of a teaching hospital was referred for an opinion for Infectious Diseases. He had a short history of illness, about four days of fever, rapidly evolving skin rash, worsening breathlessness and low platelets (count of 7000). A diagnosis of Dengue hemorrhagic fever was made. However, patient was on ventilator by day five, had cardiac tamponade, tense ascites and large bilateral pleural effusions.
Based on a rapidly worsening clinical condition, a decision to use immunoglobulins was taken after discussing risk with patients’ family. By day three all parameters began to show improvement and by day five he was significantly better. Patient was extubated by day ten and discharged in additional seven days. The role of immunoglobulins in viral hemorrhagic fevers is clearly defined, though not as clear in dengue hemorrhagic fever. This patient account is to illustrate that while there are defined boundaries in practice, patients who have life threatening infection should be assessed on an individual basis.
|Dr. Om Shrivastav |
(M.D. ( Medicine ), Infectious diseases specialist )