TNF and Acute hepatitis: Infection with dengue virus stimulates a cytokine storm often called a cytokine Tsunami causing the concentrations of different cytokines like interleukins, tumor necrosis factor-α, and interferon-γ to reach peaks.12 The higher level of AST compared to ALT could be due to the release of the enzymes from the damaged myocytes, which helps to differentiate dengue infection from other acute hepatitis caused by Hepatitis A, B, and C because of their reverse AST/ALT pattern.1,5