Response to: Adrenal haemorrhage and COVID-19 vaccine-induced immune thrombotic thrombocytopenia: correspondence

Dear Editor,

We are delighted to respond to the correspondence made by Mungmunpuntipantip et al. for his insightful and relevant comments regarding our article.¹

Dengue infection, the most common arboviral disease in the tropical area, infected with one of four dengue viruses (dengue virus type 1 through dengue virus type 4), was transmitted between humans by mosquitoes.² The common clinical manifestations of dengue infection include fever, headache, skin rash, nausea, vomiting, retro-orbital pain, abdominal pain, arthralgia and adrenal insufficiency. Severe dengue infection may present shock, severe bleeding, altered mental status or organ failure.³ Laboratory examinations are characterized by elevated liver enzymes, leukopenia and a rapid decline in platelet count. Diagnosis of dengue infection can be established via reverse-transcriptase polymerase chain reaction assay or nonstructural protein 1.⁴ Some reports indicate a low level of serum cortisol in children with severe dengue shock syndrome; however, it remains a lack of evidence for using corticosteroids in the management of dengue-related shock in children or adults.⁵ Because of the similarities of clinical presentation such as headache, abdominal pain, thrombocytopenia or adrenal problems between dengue infection and VITT, physicians should be careful to make the differential diagnosis.

Acknowledgments

The authors would like to thank the staff and researchers at the Taoyuan Armed Forces General Hospital, and Medical Affairs Bureau, Ministry of National Defense, Taiwan.

Conflict of interest. None declared.

Author notes

Hann-Yen Shyu, Yung-Hsi Kao and Po-Jen Hsiao contributed equally to this work.