Is dengue virus another viral trigger for SARDS?

Systemic inflammatory rheumatic diseases (SARDS) are often linked to a trigger by a viral infection such as Epstein-Bar Virus and cytomegalovirus. According to a new study, dengue has been attributed to be a trigger or associated with SARDS.

An interest nationwide, population-based case-control study conducted among 17,126 subjects found that a history of dengue fever is significantly associated with the risk of SARDS. The association was found to be significantly high when the interval between dengue infection and the diagnosis of SARDS was <3 months.

However, there was no statistically significant association between dengue infection and systemic sclerosis.

SARDs develop due to dysregulated immune systems and a lack of tolerance to self-antigens. Although the exact etiology of SARDs has not been elucidated; genetics, infections, and environmental predisposing factors do play a role in developing the disease. Dengue infection poses a major global health burden, accounting for around 390 million infections and 96 million cases annually.

Fever, spontaneous bleeding, persistent myalgia or arthralgia, low platelet count, and organ failure are the characteristic feature of dengue fever; DENV-1, DENV-2, DENV-3, and DENV-4 are the 4 major virus serotypes.

Although the exact pathophysiology underlying the autoimmune dengue infection has not been clearly elucidated, previous studies have shown that the infection is associated with the development of Reiter’s syndrome, multiple sclerosis, myasthenia gravis, autoimmune encephalomyelitis, systemic vasculitis, SLE, and primary adrenocortical insufficiency.

An earlier study by Talib et al. has also reported a rare case of systemic lupus erythematosus and lupus nephritis triggered by dengue. It was reported during the outbreak of dengue fever occurred in 2012 in Maharashtra, India. During the initial days of febrile illness, the dengue fever was confirmed by the presence of NS-1. Subsequent kidney tissue biopsy revealed evidence of lupus nephritis through microscopic examination and immunofluorescence.

Further interpretation of the report interpreted confirmed the diagnosis as focal proliferative glomerulonephritis and segmental sclerosis (stage IIIC).

The present findings highlight the need to consider the dengue-induced lupus flare in rare situations for appropriate and effective management.