A vector borne, airborne and food borne infection with secondary hemophagocytic lymphohistocytosis: Case of triple infections in an immuno-competent patient.

Pakistan is endemic to several bacterial, parasitic and viral infections including tuberculosis, malaria and dengue that account for a high rate of mortality each year. These different types of infections can occur through various routes of transmission and concurrently in individuals, especially in immunocompromised but rarely among immunocompetent. We report a case of a 25 year old immunocompetent female who was admitted with an initial diagnosis of dengue fever and diagnosed as having co-infection of COVID-19 and Brucella leading to secondary hemophagocytic lymphohistiocytosis (HLH).

A curious case of expanded dengue syndrome.

Dengue fever (DF) primarily presents with fever, headache, malaise, bleeding manifestations and haemoconcentration. World Health Organization (WHO) classifies DF according to levels of severity: (a) without warning signs; (b) with warning signs, such as abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, increasing haematocrit and thrombocytopenia; and (c) severe dengue with severe plasma leakage, severe bleeding or organ failure. Atypical clinical presentations of DF are defined as expanded dengue syndrome: this includes renal, cardiac, hepatic or cerebral damage.