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(Reference retrieved automatically from Google Scholar through information on FAPESP grant and its corresponding number as mentioned in the publication by the authors.)

A novel association of acquired ADAMTS13 inhibitor and acute dengue virus infection

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Author(s):
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Rossi, Fernanda C. [1] ; Angerami, Rodrigo N. [1] ; de Paula, Erich V. [1] ; Orsi, Fernanda L. [1] ; Shang, Dezhi [1] ; del Guercio, Vania M. [1] ; Resende, Mariangela R. [1] ; Annichino-Bizzacchi, Joyce M. [1] ; da Silva, Luiz J. [1] ; Zheng, X. Long [1] ; Castro, Vagner [2]
Total Authors: 11
Affiliation:
[1] Novartis Vaccines & Diagnost Srl, Epidemiol Grp, Siena - Italy
[2] Univ Estadual Campinas, UNICAMP, Hosp Clin, Hematol & Hemotherapy Ctr, BR-13083878 Campinas, SP - Brazil
Total Affiliations: 2
Document type: Journal article
Source: Transfusion; v. 50, n. 1, p. 208-212, 2010.
Web of Science Citations: 12
Abstract

BACKGROUND: Dengue is a mosquito-borne viral disease with an increasing incidence worldwide. Thrombocytopenia is a common finding in dengue virus (DV) infection; however, the underlying mechanisms remain unknown. CASE REPORT: Here we provide the first evidence of a case of antibody formation against ADAMTS13 (ADAMTS13 inhibitor) in the course of a severe acute DV infection resulting in thrombotic microangiopathy (TMA). The patient presented with classical dengue symptoms (positive epidemiology, high fever, myalgia, predominantly in the lower limbs and lumbar region for 1 week) and, after 11 days of initial symptoms, developed TMA. Clinical and laboratorial investigation of dengue and TMA was performed. RESULTS: The patient presented with ADAMTS13 inhibitor (IgG) during the acute phase of the disease, without anti-platelet antibodies detectable. Dengue infection had laboratorial confirmation. There were excellent clinical and laboratory responses to 11 serial plasma exchanges. Anti-ADAMTS13 inhibitor disappeared after remission of TMA and dengue resolution. No recurrence of TMA symptoms was observed after 2-year follow-up. CONCLUSIONS: Although the real incidence of dengue-related TMA is unknown, this case provides the basis for future epidemiologic studies on acquired ADAMTS13 deficiency in DV infection. The prompt clinical recognition of this complication and early installment of specific therapy with plasma exchange are likely to improve the outcome of severe cases of dengue. (AU)