Abstract Ref Number = APCP758
Deep Vein Thrombosis in Child with Flare Systemic Lupus Erythematosus Induced by Dengue Infection A Case Report
Afiarina Dhevianty,Sumadiono Sumadiono,Cahya Dewi Satria
Department of Child Health Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada Dr Sardjito General Hospital Yogyakarta
Background : Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder. Inflammation in autoimmune disease may drive venous and microvascular thrombosis. Deep vein thrombosis (DVT) is manifestation of potentially lethal venous thromboembolism. The aim of this case report was to report DVT in child with SLE induced by Dengue infection.
Case Presentation Summary : An 8-years-and-6 months-old boy during maintenance therapy of SLE had flare up induced by dengue infection. There were classical signs and laboratory finding (platelet: 64,000/ mm3, positive IgM and IgG) support to Dengue infection. Hematemesis and epistaxis occured with following laboratory result; D-dimer 1101 ng/ml, fibrinogen 157 mg/dL, platelet: 23,000/mm3, PPT 15.2 seconds, APTT 73.3 seconds at 7th day of fever. Patient experienced pain and progressive swelling in upper left arm beginning on 8th day of fever followed by decreasing hemoglobin and hematocrit. As the swelling and hematoma enlarged, the Doppler ultrasound showed thrombus in proximal part of left brachial vein, hematoma in left subclavian and axillary veins. Patient was managed as flare up of severe SLE and given intravenous immunoglobulin (IVIG), high dose methylprednisolon (MP), cyclophosphamide, oral MP and mycophenolate mofetil (MMF). Heparin 75 IU/kgBW also administered intravenously. There was recovery of swelling in upper left arm during 14 days.
Learning Points/Discussion : Dengue infection can induced flare up on SLE. Deep vein thrombosis in flare up SLE was resolved by severe SLE protocol therapy and heparin administration.
Keywords: systemic lupus erythematosus deep vein thrombosis dengue child