Abstract
Mentor: Nicholas Streck Program: Pathology Type: Case Report Background: A 72-year-old male with chronic kidney disease status post renal transplant presented to a Mexican hospital with fever, malaise, weakness, and decreased oral intake. He was found to have pleural effusion, acute renal failure, thrombocytopenia, and coagulopathy. He was diagnosed with dengue with warning signs by non-structural protein 1 antigen and IgM antibody and treated with oxygen, diuresis, and anticoagulation reversal with Vitamin K and fresh frozen plasma. After five days of hospitalization, his symptoms improved; however, his renal function worsened, and he was discharged to follow up in the United States. Case: He returned to the United States and was admitted for hypotension, tachycardia, and bilateral upper extremity edema. His leukopenia and thrombocytopenia persisted, and he was evaluated for other co-infections that may have prolonged his dengue symptoms. Blood cultures were positive for multidrug resistant extended spectrum beta-lactamase E. coli; all other studies returned negative. Dengue serologies repeated on day twenty after symptom onset were positive for NS1 antigen, IgM, and IgG, suggesting a prolonged critical phase of infection. Immunosuppression was decreased, and he was placed on eight days of ertapenem therapy. He underwent fluid resuscitation and received three units of platelets for continued mucosal bleeding. His leukopenia and thrombocytopenia improved, and his renal function returned to baseline. He was discharged home after nine days of hospitalization. Conclusion: This case demonstrates the importance of knowledge of uncommon disease processes and management with co-morbid conditions. One week post discharge, his laboratory data normalized, and his anticoagulation restarted.