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Open Access Research article

Extensive haemorrhagic necrosis of liver is an unpredictable fatal complication in dengue infection: a postmortem study

SAM Kularatne1, IVB Imbulpitiya2, RA Abeysekera2*, RN Waduge3, RPVJ Rajapakse4 and KGAD Weerakoon5

Author Affiliations

1 Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka

2 Medical Unit, Teaching hospital, Peradeniya, Sri Lanka

3 Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka

4 Department of Veterinary Pathobiology, Faculty of Veternary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka

5 Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka

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BMC Infectious Diseases 2014, 14:141  doi:10.1186/1471-2334-14-141

Published: 14 March 2014



Dengue infection carries a potential risk of death despite stringent management of plasma leak and haemorrhage. It appears that the extent of liver dysfunction determines the outcome.


We present a postmortem study of five patients, died of dengue shock syndrome who had markedly elevated liver enzymes and irreparable circulatory failure.


All were females with a median age of 46 years (range 20–50 years). All had positive NS1 and IgM. Clinically, one patient developed severe degree of hepatic encephalopathy whilst three patients developed uncontrollable bleeding manifestations. Dengue virus was detected in three liver specimens by reverse transcription PCR. Histology of the liver revealed massive necrosis with haemorrhages in these patients with evidence of micro and macrovesicular steatosis with significant periportal inflammatory infiltrate. No significant ischaemic changes or necrosis was observed in the other organs.


Severe haemorrhagic necrosis of the liver was the cause of death in these patients probably due to direct viral infection. Predilection for severe liver disease remains unknown. Therefore, it is prudent to think beyond plasma leak as the main pathology of dengue infection and attempts should be made to develop other treatment modalities to prevent and manage unforeseen fatal complications of dengue infection.

Dengue fever; Liver cell necrosis; Acute liver failure; Autopsy study