Vaso‐occlusive crisis in a sickle cell patient after transfusion‐transmitted dengue infection

Case Report A 26‐year‐old woman with sickle cell disease (SCD) on chronic transfusion therapy complained of severe arthralgia, myalgia, abdominal pain, headache, and fever 24 hours after transfusion of a red blood cells (RBCs). Dengue virus (DENV) infection was suspected and the patient was hospital...

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Bibliographic Details
Published in:Transfusion (Philadelphia, Pa.) Pa.), 2020-09, Vol.60 (9), p.2139-2143
Main Authors: Santos, Flávia L. S., Slavov, Svetoslav N., Bezerra, Rafael S., Santos, Elaine V., Silva‐Pinto, Ana C., Morais, Ana L. L., Sá, Mariana B., Ubiali, Eugênia M. A., De Santis, Gil C., Covas, Dimas T., Kashima, Simone
Format: Article
Language:English
Subjects:
Arthralgia
Blood transfusion
Dengue fever
Differential diagnosis
Disease transmission
Erythrocytes
Fever
Genotypes
Headache
Hemoglobin
Infections
Myalgia
Pain
Phylogeny
Polymerase chain reaction
Sickle cell disease
Signs and symptoms
Transfusion
Vector-borne diseases
Viral diseases
Viruses
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Summary:Case Report A 26‐year‐old woman with sickle cell disease (SCD) on chronic transfusion therapy complained of severe arthralgia, myalgia, abdominal pain, headache, and fever 24 hours after transfusion of a red blood cells (RBCs). Dengue virus (DENV) infection was suspected and the patient was hospitalized for clinical support and RBC transfusion, to lower the hemoglobin S to less than 30%. The patientʼs clinical condition improved approximately 8 days after the onset of symptoms. Results DENV type 2 (DENV‐2) TaqMan real‐time polymerase chain reaction was negative in the patient's pretransfusion sample while the posttransfusion sample was positive (Ct, 27.8), suggesting a high viral load and an acute infection. To investigate DENV transfusion transmission (TT‐DENV) the stored donor serum was tested and was also positive (Ct, 25.8). Molecular typing confirmed the presence of DENV‐2. The phylogenetic analysis of the DENV‐2 strains obtained from both donor and patient samples were classified as the Southeast Asia‐American genotype (Genotype III) and demonstrated 100% genomic identity, indicating TT‐DENV. Conclusion This is the first description of TT‐DENV in a SCD patient. A presumed high viral load in the transfused RBC unit probably determined the early clinical manifestation. In endemic regions dengue fever should be considered as differential diagnosis in SCD patients with fever and acute pain crisis, mainly during DENV outbreaks.
ISSN:0041-1132
1537-2995
DOI:10.1111/trf.15968