Uncommon Presentation of Dengue Fever Section in a G6PD-Deficient Adult: A Case Report

Dengue fever presents a diverse clinical spectrum which can lead to many complications. The outcome of these presentations predominantly depends on early diagnosis and judicious management. While complications involving the haematological system, such as cytopenia and bleeding, are well-known in severe dengue infections due to various factors, the occurrence of haemolytic anaemia in dengue fever is rare. An alteration in the redox state of immune cells due to Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency may lead to atypical presentations of dengue infection, such as intravascular haemolysis. A 37-year-old male initially presented to the emergency department with a 6-day history of fever, red-colored urine and severe shortness of breath. Routine tropical fever work-up detected an infection with the dengue virus, while severe enzyme deficiency was attributed as the cause of haemolysis. The presence of splenomegaly, haematuria, hyperferritinaemia, transaminitis and raised triglycerides was suggestive of Macrophage Activation Syndrome (MAS), which was confirmed through a bone marrow biopsy. He was diagnosed with dengue fever, complicated by MAS and haemolytic anaemia due to G6PD deficiency.