In addition to these,
other atypical manifestations including encephalitis, rhabdomyolysis,
acute motor quadriparesis, and hemophagocytic
syndrome (HPS) have also been described for severe
dengue
HPS is characterized by uncontrolled activation of normal
T lymphocytes and macrophages, leading to overwhelming
production of pro-inflammatory cytokines
which can cause hyperinflammation .
HPS-associated dengue disease was reported as early as
1966 , and to date at least 44 case reports of
HPS in dengue have been reported in the literature. HPS
has been described especially in severe dengue and reports of HPS in confirmed
dengue cases, presented clinical and diagnostic features
similar to those of HPS which include hyperferritinemia
and hemophagocytosis activity in the bone marrow.