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Indian J Crit Care Med. 2017 August; 21(8): 540–541.
PMCID: PMC5588495

Dengue and Thrombotic Thrombocytopenic Purpura

Sir,

The publication on “Dengue and Thrombotic Thrombocytopenic Purpura (TTP) is very interesting.”[1] Gavali et al. reported a case and raised a conclusion that “timely diagnosis and starting appropriate treatment immediately are key factors for successful outcome.”[1] It is no doubt that TTP can be a complication of dengue. TTP in dengue is sporadically reported and it can be easily missed due to lack of complete diagnostic investigation.[2] Deepanjali et al. noted that “jaundice with a disproportionate elevation of serum aspartate aminotransferase level in a patient with dengue should arouse the suspicion of TTP.”[3] Nevertheless, this important observation was not seen in the present case report by Gavali et al.[1]

In the present case, it is no doubt that there was a co-occurrence of dengue and TTP. However, there are other important concerns. First, there are also other arbovirus infections that might induce TTP such as chikungunya that might be a forgotten concurrent infection.[4] Second, there are also other possible common underlying causes of the reported clinical features that are not ruled out. The important examples are Vitamin B12 and Vitamin D deficiencies.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

REFERENCES

1. Gavali AS, Shelgaonkar J, Bartakke S. Thrombotic thrombocytopenic purpura in a case of dengue fever: A rare presentation. Indian J Crit Care Med. 2017;21:226–8. [PMC free article] [PubMed]
2. Wiwanitkit V. Dengue fever: Diagnosis and treatment. Expert Rev Anti Infect Ther. 2010;8:841–5. [PubMed]
3. Deepanjali S, Naik RR, Mailankody S, Kalaimani S, Kadhiravan T. Dengue virus infection triggering thrombotic thrombocytopenic purpura in pregnancy. Am J Trop Med Hyg. 2015;93:1028–30. [PMC free article] [PubMed]
4. Epelboin L, Bidaud B, Mosnier E, Le Turnier P, Vesin G, Walter G, et al. Fatal case of chikungunya and concomitant thrombotic thrombocytopenic purpura in French Guiana during air flight medical evacuation. J Travel Med. 2017;24 Doi: 10.1093/jtm/tax028. [PubMed]
5. Mishra VA, Harbada R, Sharma A. Vitamin B12 and vitamin d deficiencies: An unusual cause of fever, severe hemolytic anemia and thrombocytopenia. J Family Med Prim Care. 2015;4:145–8. [PMC free article] [PubMed]

Articles from Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine are provided here courtesy of Wolters Kluwer -- Medknow Publications