(1678) Vaccine-Related Dengue Shock Syndrome: A Case Report

Introduction: Dengue fever has grown exponentially over the last two decades, primarily related to global warming, becoming a health preoccupation, especially in South America and Africa. Vaccines are being developed to help prevent severe dengue infections. These vaccines are attenuated virus vaccines and are contraindicated in immunocompromised patients. To this day there has not been reported any cases of severe dengue or dengue shock related to vaccination.

Description: A 69 y/o male with medical history of rheumatoid arthritis and psoriasis, medicated with monthly Adalimumab, received Dengue vaccine (QDENGA) without medical consultation. Twenty days after vaccination the patient was admitted to our hospital, in Pilar, Buenos Aires, due to a cardiogenic shock, requiring mechanical ventilation, vasopressor and inotropic support, and diuretic treatment (noradrenaline, vasopressin, dobutamine and furosemide). At admission he had an APACHE II = 26, and SOFA =10.
Given the worsening of the cardiogenic shock, it was decided to insert an intra-aortic balloon pump (IABP). A coronary angiography was performed, showing no critical coronary disease. 
Forty-eight hours later the patient persisted with shock, with a pulmonary artery catheter measurement suggesting mixed shock (low resistances, high wedge and an increased cardiac output). Because of this change in the hemodynamic profile diuretics were suspended, IABP was weaned and removed, after fluid resuscitation.
The patient evolved with recovery of his organ failures. He had negative Dengue antibodies (IgM and IgG) with a positive Dengue antigen, interpreting the case as a dengue shock syndrome related to vaccination in an immunocompromised host. After a month in the ICU the patient was discharged, and 6 months later is fully recovered.

Discussion: Although it is rare, the lack of evidence in the literature led us to present this case because patients who have received the dengue vaccine can exhibit severe manifestations of dengue, particularly if they are immunocompromised. We emphasize the contraindication of the vaccine in immunocompromised patients.