Experience using Intravenous N-Acetylcistein in Severe Dengue Induced Acute Liver Failure: A Rare Case Report

Dengue is one of the common harmful mosquito borne-viral disease which belongs to the Flaviviridae family1. There are different dengue virus serotypes causing dengue disorders, including, asymptomatic infection, dengue fever, undifferentiated fever, fatal and severe dengue hemorrhagic fever. Aedes aegypti mosquito (main-urban-vector) and Aedes albopictus female mosquitos are the known vector for transmission of dengue virus from an infected person to others by biting2. Dengue a growing public health concern approximately four billion people in 130 countries identified at risk of infection. As of 30 april 2024, 7.6 million dengue cases have been reported to WHO in 2024, including 3.4 million confirmed cases, over-16000 severe cases, and over-3000 deaths3. Incidence of hepatic dysfunction in children with dengue is quoted to be as high as 90%. Acute liver failure (ALF) can rarely occur, less than 1% of cases and is associated with poor outcome with mortality rate of up to 50%4. N-acetylcysteine (NAC), which is used for the treatment of nasal congestion disorder and paracetamol overdose toxicity, could be used as a definitive therapy for dengue virus induced ALF5. We report a case of a 12-years-old boy with severe dengue induced acute liver failure in whom intravenous (iv) NAC was used-successfully.