Background: Dengue Hemorrhagic Fever/Dengue Shock Syndrome (DHF/DSS) occurs only in a small number of dengue fever (DF). This condition, when coupled with a form of congenital hemolytic anemia called Hereditary Spherocytosis (HS), will turn a relatively manageable case of DF into a complicated condition with very poor prognosis.

Case Presentation: Here we report a case of a 19-year-old male student from Manila who came in with fever, jaundice, and dengue warning signs. He was also diagnosed with HS. This compounding infection initiated a hemolytic crisis of his HS, causing severe bleeding and multiple organ failure on top of DHF/DSS. The progression of the disease started with bleeding, and later on with altered sensorium (encephalopathy), respiratory failure, and ultimately, demise.

Conclusion: DHF/DSS together with HS may cause a hemolytic crisis. High RBC turnover and heightened erythroid marrow activity in HS makes a patient vulnerable to develop aplast ic cris is due to dengue virus infection. Erythroid marrow failure may result in profound anemia, heart failure, hypoxia, cardiovascular collapse, and death.

Keywords: Dengue Hemorrhagic Fever/Dengue Shock Syndrome, Hereditary Spherocytosis

1. Barcellini W, et al. Hereditary cell membrane defects: diagnostic and clinical aspects. Blood Transfus, 2011; 9: 274-277.
2. Huq S, et al. Hereditary spherocytosis. J Health Popul Nutr, 2010. 28(1): 107-109.
3. Mandell G, et al. Dengue and Dengue Hemorrhagic Fever/ Dengue Shock Syndrome. Principles and Practice of Infectious Diseases 7th ed. Churchill Livingstone Elsevier; 2010.
4. Guzman M, et al. The complexity of antibody-dependent enhancement of dengue virus infection. Viruses, 2010; 2: 2649-2662.
5. Sharma S, et al. Clinical profile of dengue infection in patients with haematological diseases. Mediterr J Hematol Infect Dis, 2011.
6. Kamoun T, et al. Acute erythroblastopenia due to parvovirus B19 revealing hereditary spherocytosis. Arch Pediatr, 2011; 18(9): 990-992.
7. Tavil B, et al. Aplastic crisis induced by human parvovirus B19 infection as initial presentation of hereditary spherocytosis. Indian J Pediatric, 2010; 77(10): 1191-1192.
8. Zaki Mel S, et al. Parvovirus B19 infection in children with variety of hematolgical disorders. Hematology, 2006; 11(4): 261-266.
9. World Health Organization. Dengue Guidelines for Diagnosis, Treatment, Prevention, and Control. WHO, 2009.
10. Halstead S. Dengue. Lancet, 2007; 370: 1644-1652.
11. Vaughn D, et al. Dengue viremia titer, antibody response pattern, and virus serotype correlate with disease severity. J Infect Dis, 2000; 181 :2-9.
12. Kurane I, et al. Antibody-dependent enhancement of dengue virus infection. Rev Med Virol, 1991; 1: 211-221.
13. McBride W, et al. Dengue viral infections; pathogenesis and epidemiology. Microbes and Infection, 2000; 2; 1041-1050.
14. Kumaria R. Correlation of disease spectrum among four dengue serotypes: a five years hospital based study from India. Braz J Infect Dis, 2010; 14(2): 141-146.
15. Oliveira G, et al. Severe hepatitis and jaundice during the evolution of dengue virus infection: case report. Rev Soc Bras Med Trop, 2010: 43(3) 339-41.
16. Viswanathan S, et al. Fatal fulminant hepatic failure in a diabetic with primary dengue. Trop Med, 2010; 413561.
17. Seneviratne S, et al. Pathogenesis of liver involvement during dengue viral infections. Trans R Soc Trop Med Hyg, 2006; 100: 608-614.
18. Ling L, et al. Fulminant hepatitis in dengue hemorrhagic fever. J Clin Virol, 2007; 38: 265-268.
19. Thomas L, et al. Predictors of severe manifestations in a cohort of adult dengue patients. J Clin Virol, 2010; 48: 96-99.
20. Rigau-Perez J, et al. Dengue and dengue haemorrhagic fever. Lancet, 1998; 352: 971-977.
21. Mei-Chuan K, et al. Impact of renal failure on the outcome of dengue viral infection. Clin J Am Soc Npehrol, 2008; 3: 1350-1356.
22. Mariani M, et al. Clinical and hematologic features of 300 patients affected by hereditary spherocytosis grouped according to the type of membrane defect. Haematologica 2008; 93(9): 1310-1317.