Hemophagocytic syndrome secondary to dengue: a serious complication in vulnerable patients

Introduction: Hemophagocytic syndrome (HPS) was identified as a rare immunological condition characterized by a dysregulated activation of the immune system, which caused severe systemic inflammation and multiple organ failure. It presented in primary forms, of genetic origin, and secondary forms, associated with infections, neoplasms and autoimmune diseases. In particular, the dengue virus was recognized as a relevant trigger of HS, especially in pediatric populations in endemic regions, where its early diagnosis represented a great clinical challenge. Development: The work addressed the pathophysiology of HS, in which an exaggerated activation of macrophages and cytotoxic T lymphocytes was described, together with a hypersecretion of pro-inflammatory cytokines. This uncontrolled immune reaction generated manifestations such as persistent fever, pancytopenia, hepatosplenomegaly and hyperferritinemia. The diagnosis was based on clinical and laboratory criteria established by the Histiocyte Society, with the identification of hemophagocytosis in bone marrow or other tissues being essential. Treatment strategies included intensive life support, the use of corticosteroids, intravenous immunoglobulins and, in severe cases, immunosuppressants, with special attention to the associated risks in patients with dengue. It was concluded that HS secondary to dengue represented a serious and little recognized complication, whose timely diagnosis was essential to improve the prognosis. The study highlighted the importance of strengthening clinical surveillance, updating management protocols and training health personnel to effectively deal with this condition in contexts of high dengue prevalence.