| Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access |
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Case Report
Volume 16, Number 8, August 2025, pages 293-299
Dengue Virus Transmission via Deceased Renal Allograft: A Case Report Highlighting the Need for Donor Screening in Endemic Areas
Table
| Number | Reference | Journal | Age/gender | Type of renal transplantation | Clinical features & diagnostic test | Immunosuppression | Management | Outcome |
|---|---|---|---|---|---|---|---|---|
| DVI: dengue virus infection; F: female; M: male; Pred: prednisolone; MMF: mycophenolate mofetil; TAC: tacrolimus; ALT: alanine aminotransferase; AST: aspartate aminotransferase; MP: methylprednisolone; UTI: urinary tract infection; Ig: immunoglobulin; ATG: antithymocyte globulin; IV intravenous; E. coli: Escherichia coli; RT-PCR: reverse transcription polymerase chain reaction; NS1: non-structural protein 1; DENV-1: dengue virus serotype 1. | ||||||||
| Case 1 | Rosso et al, 2018 [5] | Braz J Infect Dis | 31/F | Deceased kidney transplantation | Needed readmission. Presented on day 8 with fever, vomiting, diarrhea, jaundice. Thrombocytopenia, lymphopenia, hepatitis. Pain over the graft with perirenal hematoma of 1,300 mL | Pred, cyclosporine (CyA), MMF | Drainage of perirenal hematoma and transfusion of red blood cells, platelets, and fresh frozen plasma | Alive and was discharged on day 25 |
| Donor serum retrospectively checked and found to be NS1 antigen positive | IgG+ IgM+ | |||||||
| NS1+ RT-PCR+ (DEN4) | No comment on modification of immunosuppression | |||||||
| Case 2 | Rosso et al, 2018 [5] | Braz J Infect Dis | 48/F | Deceased kidney transplantation | Presented on day 4 with fever and elevation of transaminases | Pred, CyA, MMF | Asymptomatic and conservative management. Patient was given oral ciprofloxacin for UTI. | Alive |
| Donor serum was retrospectively checked and found to have NS1 antigen | Has E. coli UTI | |||||||
| IgG- IgM+ NS1- PCR- | ||||||||
| Case 3 | Lecadieu et al, 2021 [17] | Am J Trop Med Hyg | 58/M | Deceased kidney transplantation | Has delayed graft function and presented on day 11 with hemodynamic instability (blood pressure 76/43 and heart rate 119, abdominal pain, peri-graft infected collection, anemia, thrombocytopenia, and deranged liver enzymes. | ATG, MP, MMF, TAC | Needed vasopressors, ventilation, and dialysis, and needed transfusion of platelet concentrate, packed red cells, and fresh frozen plasma. The course was complicated by an infected hematoma caused by Staphylococcus epidermidis (treated with vancomycin) and ventilator-associated pneumonia by Klebsiella pneumoniae, treated with meropenem | Alive and discharged on day 39 with creatinine 288 µmol/L |
| Blood PCR positive for DENV-1 | ||||||||
| Case 4 | Lecadieu et al, 2021 [17] | Am J Trop Med Hyg | 61/M | Deceased kidney transplantation | Presented on day 12 with thrombocytopenia (64 × 109/L) and deranged liver enzymes (AST 220 IU/L and ALT 181 IU/L) and a normal clinical examination. | ATG, MP, MMF, TAC | Treated symptomatically | Discharged home on day 35 with creatinine 271 µmol/L |
| Both blood and urine PCR were positive for DENV-1, and dengue serology was negative (IgM index 0.5 and IgG index 0.1). | ||||||||
| Case 5 | Sim et al, 2021 [18] | Am J Transplant | 63/M | Deceased kidney transplantation | Presented on day 5 with fever, thrombocytopenia, and deranged liver enzymes. No delayed graft functions | Induction basiliximab | Recovered uneventfully and was discharged home | |
| Donor negative by blood RT-PCR. However, urine RT-PCR positive | RT-PCR detected | Maintenance TAC, Pred, and MMF. No comment about modification of immunosuppression | ||||||
| Case 6 | Sim et al, 2021 [18] | Am J Transplant | 39/M | Deceased kidney transplantation | Asymptomatic with normal platelet count and mildly high alanine transaminase | Induction with ATG and MP | Recovered uneventfully and was discharged home. | |
| Donor negative by RT-PCR. However, urine RT-PCR was positive | ||||||||
| Maintenance with TAC, Pred, and MMF. No comment about the modification of immunosuppression | ||||||||
| Case 7 | Tan et al, 2005 [19] | Nephrol Dial Transplant | 23/M | Live kidney transplantation | Presented on day 5 with fever, gastrointestinal bleeding, thrombocytopenia, leukopenia, right effusion, hemorrhagic ascites, and a large retroperitoneal hematoma arising from the bed of the transplanted kidney | Induction MP | His MMF was stopped; packed red cell and platelet transfusions were given; granulocyte colony-stimulating factor given; hematoma drained surgically. | Full recovery and graft function remained excellent |
| A donor had dengue fever 6 months back | RT-PCR detected | Pred, TAC, MMF | ||||||
| Case 8 | Tangnararatchakit et al, 2012 [20] | Transplant Proc | 15/F | Live kidney transplantation | Presented with perinephric hematoma, pancytopenia, ascites, effusion, and shock | Induction with MP followed by Pred, cyclosporine, MMF | Patient was treated via surgical drainage, transfusions, and hemodynamic support | Patient survived with full recovery of graft function |
| Case 9 | Present case 1 | 27/F | Deceased kidney transplantation | Presented on day 11 with fatigue, hematoma, anemia, thrombocytopenia, deranged liver enzymes, and coagulopathy | Induction with ATG | MMF was held; IV fluid given; packed red cells, platelets, and FFP were given; hematoma was drained. | Discharged on day 20 with creatinine of 144 µmol/L | |
| RT-PCR detected dengue | Maintenance with Pred, MMF, TAC | |||||||