Unveiling Hyperinflammation in Severe Dengue With Coinfection Among Children: A Case Series

Dengue illness follows three phases: febrile, critical, and convalescent. Coinfection and hyperinflammatory response are common causes of the persistence of fever beyond the febrile phase of dengue. However, finding both these causes together in severe dengue cases is rarely reported in the literature. We present three cases of severe dengue who presented with persistent fever. The first case is of a 14-year-old girl who presented with dengue shock and culture-proven <i>Acinetobacter</i> sepsis. Later she was diagnosed with a hyperinflammatory response to infection and improved after intravenous immunoglobulin (IVIG) administration. The second case is of a 13-year-old boy who presented with severe dengue and culture-proven <i>Burkholderia</i> sepsis. He also had persistent fever despite appropriate treatment of infection which later improved after IVIG administration for hyperinflammation. The third case is of a 10-year-old girl who presented with severe dengue and encephalopathy. She was later diagnosed with coinfection with Japanese encephalitis and hyperinflammation. These cases highlighted that coinfection and hyperinflammatory response can both together complicate dengue infection.