Therapeutic plasma exchange in dengue-associated hemophagocytic lymphohistiocytosis

Hemophagocytic lymphohistiocytosis (HLH) is a rare but detrimental effect of dengue. It may be primary or secondary in nature. The uncontrolled proliferation of the histiocytes and activated lymphocytes paves the way for the cytokine storm, thereby contributing to the fatality of the disease. Dengue-associated HLH should be considered for all cases of severe dengue in addition to the clinical criteria. In order to mitigate such high mortality, it is only peremptory to perform early intervention following the early identification of the condition. As per the american society for apheresis (ASFA 2023), therapeutic plasma exchange (TPE) plays a supportive role in the management of HLH to stabilize the organ functions. It is a Category III Grade 2C recommendation. It acts as an adjunct to the immunosuppressive and cytotoxic drugs such as steroids, intravenous immunoglobulin or cyclosporines, and etoposide. There is limited but supportive evidence with respect to the management of secondary HLH with TPE. We present a case report of dengue-associated secondary HLH managed in our hospital with the help of TPE.