Effect of a single dose of methyl prednisolone as rescue medication for patients who develop hypotensive dengue shock syndrome during the febrile phase: a retrospective observational study

The dengue fever (DF) epidemic in 2009 in Sri Lanka resulted in nearly 370 deaths (1.4% case fatality), mainly adults. Although dengue shock syndrome (DSS) is thought to occur during the immediate afebrile phase of dengue infection, we encountered adult patients developing hypotensive DSS during the febrile phase. Although steroids have been shown to decrease cell infection rates and inhibit pro-inflammatory cytokines, existing data do not recommend routine use of steroids in the management of DF. However, due to the higher-than-usual mortality during the current epidemic here, many clinicians used steroids empirically, usually as rescue medication. Studies that have assessed the effects of steroids in DF have all been in children. Some show no benefit in established DSS, while two have shown benefits with high-dose methyl prednisolone. A possible role for steroids in complicated adult DF has not been investigated.