Dengue Myocarditis: A Case Report and Major Review

Abstract

Dengue is a viral disease transmitted by the bite of a female arthropod, prevalent primarily in tropical and subtropical regions. Its manifestations include asymptomatic infections, dengue fever, and a severe form called hemorrhagic dengue or dengue shock syndrome. Atypical manifestations can also occur, called expanded dengue syndrome. We describe the case of a 43-year-old man with an unusual presentation of dengue, demonstrating a workup suggestive of myocardial and pericardial damage. Symptoms and markers indicative of cardiac compromise improved after five days on anti-inflammatory treatment. Dengue myocarditis is considered an uncommon complication of dengue, although its reported incidence is likely an underestimation. In general, most cases of dengue myocarditis are self-limited, with only a minority at risk of progressing to heart failure. In order to improve recognition and prevent progression, healthcare providers should maintain a high degree of suspicion regarding potential cardiac complications in patients with dengue.

Keywords: Acute myocarditis; dengue; expanded dengue syndrome.

Figure 1

Electrocardiogram with ST segment elevation.

Figure 2

Echocardiogram of the short axis with thickening of the parietal pericardium.

Figure 3

Cardiac MRI showing hyperemia in the basal portion.

Figure 4

Cardiac MRI with triple IR sequencing showing hyperintense signal, compatible with myocardial edema.

Figure 5

Cardiac MRI with late gadolinium enhancement in the inferoseptal, inferior, and inferomedial segments.

Figure 6

Dengue classification according to World Health Organization (WHO).

Figure 7

Summary of the cellular and molecular pathology of viral and autoimmune myocarditis.