We report the case of a 45-day-old girl from Leticia, Amazonas, whose mother consulted her for the second time and reported a clinical picture of four days of evolution with an increase in the size of the abdomen and persistent fever.
Clinical examination revealed edema, hematomas, abdominal distension and painful hepatomegaly with difficulty.
A nasogastric tube was drained, and the contents had been removed. Pathological examination revealed a low platelet count (26,800 per mm 3); other parameters are shown in Table 1.
The clinical picture progressed rapidly to respiratory acidosis (hypoxemia) and subsequently the child presented cardiorespiratory arrest without reaction to resuscitation maneuvers.
Samples of hepatic, splenic, pulmonary, renal and muscular cardiac tissue were taken during necropsy and sent to the laboratories of Pathology and Virology of the National Institute of Health for confirmation of the diagnosis associated with severe infection by dengue.
Medianing the routine histopathological study with hematoxylin and eosin staining of the tissues obtained at necropsy, we observed a severe liver injury associated with shock and hepatocellular necrosis in midzonal and pericentral areas as well as portal mononuclear infiltrate.
The pulmonary tissue showed edema and recent diffuse hemorrhage without pneumonia.
The splenic tissue showed cellular congestion of the white pulp associated with reactive lymphoid hyperplasia, and the renal and muscular cardiac tissues were normal, with no inflammatory processes or necrosis.
1.
Molecular examination by RT-PCR in liver tissue samples in saline solution confirmed dengue virus serotype 2 (DENV2).
In the immunohistochemistry assays, the peroxidase and lactose techniques showed that the viral antigen was distributed in all organs obtained at necropsy.
Table 2 shows the antigen distribution in different cell types.
