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Background <p>Dengue fever and malaria are major global vector-borne diseases associated with substantial clinical burden. Although typically presenting with well-characterized syndromes, both infections may rarely trigger hemophagocytic lymphohistiocytosis (HLH), a severe hyperinflammatory condition driven by uncontrolled immune activation. Early identification is crucial, as delayed diagnosis is associated with high mortality.</p> Case Series <p>Here we describe three cases of infection-associated HLH: two secondary to dengue fever and one to <i>Plasmodium vivax</i>. All patients presented with persistent fever, cytopenias, biochemical evidence of inflammation, and organ dysfunction consistent with HLH-2004 diagnostic criteria and H Score. Management involved a combination of supportive care, immunosuppressive therapy, and infection-directed treatment, with variable clinical outcomes. This underscores heterogeneity in therapeutic requirements.</p> Conclusion <p>These cases highlight the importance of maintaining a high index of suspicion for HLH in patients with dengue or malaria who demonstrate persistent cytopenias or worsening systemic inflammation, particularly when clinical progression is disproportionate to expected disease severity. Increased awareness facilitates timely diagnosis and individualized treatment, which are essential to improving outcomes in infection-associated HLH.</p>

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From Vector to Cytokine Storm: Case Series on HLH in Patients with Dengue and Malaria

  • 期刊论文

  • 发表日期：

    2026年3月17日

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  • Poonam Gupta,
  • Archit Kalra,
  • Anand Singh,
  • Ajeet Kumar Chaurasia,
  • Divya Chutani

摘要

Background

Dengue fever and malaria are major global vector-borne diseases associated with substantial clinical burden. Although typically presenting with well-characterized syndromes, both infections may rarely trigger hemophagocytic lymphohistiocytosis (HLH), a severe hyperinflammatory condition driven by uncontrolled immune activation. Early identification is crucial, as delayed diagnosis is associated with high mortality.

Case Series

Here we describe three cases of infection-associated HLH: two secondary to dengue fever and one to Plasmodium vivax. All patients presented with persistent fever, cytopenias, biochemical evidence of inflammation, and organ dysfunction consistent with HLH-2004 diagnostic criteria and H Score. Management involved a combination of supportive care, immunosuppressive therapy, and infection-directed treatment, with variable clinical outcomes. This underscores heterogeneity in therapeutic requirements.

Conclusion

These cases highlight the importance of maintaining a high index of suspicion for HLH in patients with dengue or malaria who demonstrate persistent cytopenias or worsening systemic inflammation, particularly when clinical progression is disproportionate to expected disease severity. Increased awareness facilitates timely diagnosis and individualized treatment, which are essential to improving outcomes in infection-associated HLH.