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Expanded dengue syndrome pada anak dengan gejala ensefalopati, efusi pleura, gagal hepar akut dan perdarahan gastrointestinal: laporan kasus

Abstract

Background: Dengue hemorrhagic fever is a dengue virus infection transmitted by its main vector Aedes aegypti mosquito which is spreading in tropical and subtropical areas. Dengue infection has a wide spectrum of clinical manifestations with the most severe manifestations involving the vital organs, known as expanded dengue syndrome.

Case report: We reported a case of a 1-year-old girl, with no significant medical history, referred with complaints of decreased consciousness accompanied by fever, decreased appetite, and black stools. On the results of the physical examination, there was a decrease in GCS, signs of shock, enlarged liver, and decreased vesicular breath sounds accompanied by wet crackles in the right lung. The chest radiograph showed a pulmonary edema with right pleural effusion. Laboratory examination revealed normocytic normochromic anemia, severe thrombocytopenia, prolonged coagulation factors, and acute liver failure characterized by a 70 – 100-fold increase in transaminase enzymes. There was also hypoalbuminemia, electrolyte imbalance, and a prolonged state of shock resulting in uncompensated respiratory alkalosis. The working diagnosis was dengue shock syndrome with disseminated intravascular coagulopathy, transaminitis, and encephalopathy. The patient received treatment in the intensive care unit for eight days and received fluid therapy, fresh frozen plasma and packed red cell transfusions, injection of vitamin K and furosemide, correction of albumin, electrolytes, and administration of intravenous antibiotics and corticosteroids.

Conclusion: Expanded dengue syndrome is characterized by the involvement of several organs that may lead to fatal complications. Thereby, early recognition of this syndrome can help establish a diagnosis and provide appropriate treatment to improve the outcome.

 

Latar Belakang: Demam berdarah dengue merupakan infeksi virus dengue yang ditularkan oleh vektor utama nyamuk Aedes aegypti yang tersebar di daerah tropis dan subtropis. Infeksi dengue memiliki spektrum manifestasi klinis yang luas dengan manifestasi paling berat dapat melibatkan penurunan fungsi organ yang disebut dengan expanded dengue syndrome. Penanganan yang optimal memberikan prognosis yang baik.

Laporan Kasus: Kami melaporkan seorang anak perempuan berusia 1 tahun 8 bulan, tanpa riwayat medis masa lalu yang signifikan, dirujuk dengan keluhan penurunan kesadaran diawali dengan demam, nafsu makan menurun dan buang air besar berwarna hitam. Pada hasil pemeriksaan fisik didapatkan penurunan Glasgow coma scale, tanda syok, pembesaran hepar dan suara nafas vesikular yang menurun disertai ronkhi basah pada paru kanan. Manifestasi klinis ini didukung dengan hasil rontgen toraks yang menunjukkan gambaran edema paru dengan efusi pleura kanan. Pada pemeriksaan laboratorium didapatkan anemia normokromik normositer, trombositopenia berat, pemanjangan faktor koagulasi, dan gagal liver akut yang ditandai dengan peningkatan enzim transaminase 70 – 100 kali lipat. Didapatkan juga hipoalbuminemia dan ketidakseimbangan elektrolit serta keadaan syok memanjang yang berakhir pada kondisi alkalosis respiratorik tidak terkompensasi. Diagnosis kerja dengan sindrom syok dengue dengan koagulopati intravaskular diseminata, transaminitis dan ensefalopati dengue. Pasien mendapatkan perawatan di ruang rawat intensif selama delapan hari dan mendapatkan terapi pemberian cairan, transfusi fresh frozen plasma dan packed red cell, injeksi vitamin K dan furosemide, koreksi  albumin, elektrolit serta pemberian antibiotik dan kortikosteroid intravena.

Kesimpulan: Expanded dengue syndrome ditandai dengan keterlibatan beberapa organ yang dapat menghasilkan komplikasi yang fatal sehingga pengenalan awal terhadap sindrom ini dapat membantu menegakkan diagnosis dan memberikan pengobatan yang tepat.

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How to Cite

Sriwaningsi, L., Saiya, S. ., & Indrawan, I. G. D. K. . (2023). Expanded dengue syndrome pada anak dengan gejala ensefalopati, efusi pleura, gagal hepar akut dan perdarahan gastrointestinal: laporan kasus. Intisari Sains Medis, 14(3), 1307–1312. https://doi.org/10.15562/ism.v14i3.1842

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Lina Sriwaningsi
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Selly Saiya
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I Gde Doddy Kurnia Indrawan
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