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Most U.S. physicians have had little firsthand experience with dengue fever, but global warming means that we are likely to see more of this tropical disease. Dengue's feared complication is dengue shock syndrome (DSS): vasculopathy, thrombocytopenia, and coagulopathy that probably are immune mediated, at least in part. Do steroids help forestall DSS?
In a blinded trial, Vietnamese researchers randomized 225 patients (age range, 5–20 years) with newly diagnosed dengue fever to 3 days of low-dose (0.5 mg/kg) or high-dose (2 mg/kg) oral prednisolone or placebo. Neither steroid dose affected incidence of DSS (8% overall), need for intensive care unit admission, platelet count, or any other relevant clinical endpoint. Hyperglycemia was somewhat …