Coronavirus disease 2019 (COVID-19), due to SARS-CoV-2 infection, has been a global concern since January 2020. Southeast Asia, including Bangladesh, is facing outbreaks of endemic diseases such as dengue. Here, we report the case of an eight-year-old female from Dhaka with high-grade, continued fever, shock, features of pneumonia, and plasma leakage with multiple organ dysfunction. Both nonstructural protein 1 antigen (NS1 Ag) for dengue and reverse transcription-polymerase chain reaction (RT-PCR) for COVID-19 were positive in the patient. The echocardiographic evaluation showed coronary arterial dilatations. The patient was managed according to the WHO guidelines for dengue with immunoglobulin, methylprednisolone, and aspirin for the involvement of coronary arteries. The patient required a mechanical ventilator due to pulmonary hemorrhage and unstable vitals. She showed gradual improvement with timely managements. Although a single case report does not portray the full picture, through this case report, we aim to describe the severity of co-infection of the mentioned viruses in a child in Bangladesh during the pandemic of SARS-CoV-2. Without appropriate diagnosis and management, it can be fatal.

Severe dengue with the multisystem inflammatory syndrome in children (MIS-C) can be difficult to diagnose as both diseases have similar symptoms and laboratory findings. Bangladesh is currently facing a double burden of severe dengue and SARS-CoV-2 infection. Co-infection with these viruses can result in severe morbidity. Worldwide this co-infection is rare. However, we present five cases of severe dengue with possible MIS-C due to SARS-CoV-2 infection in children. All the children presented with shock with variable degrees of plasma leakage. Mucocutaneous and gastrointestinal involvement were common. All tested positive for dengue nonstructural protein 1 antigen on the second to the third day of fever and tested positive for anti-SARS-CoV-2 IgG by enzyme-linked immunosorbent assay. Echocardiographic evaluation in all patients showed coronary arterial abnormalities. Cardiac enzymes were abnormal, and there were raised inflammatory markers and abnormal coagulation profiles. One patient had neurological involvement and needed mechanical ventilatory support. All cases were successfully managed according to dengue shock syndrome guidelines and required intravenous immunoglobulin with prednisolone, aspirin, and in some cases, enoxaparin for the management of coronary arterial involvements, which is not a documented feature for severe dengue infection, but typically found in MIS-C due to SARS-CoV-2 infection or Kawasaki disease. This case series aims to describe the possibility of co-infection of severe dengue with MIS-C due to SARS-CoV-2 infection in a dengue-endemic region during the coronavirus disease 2019 (COVID-19) pandemic, and alternatively, dengue virus as an unusual etiology for Kawasaki disease was also entertained. Severe dengue in endemic regions can coexist with COVID-19 during an outbreak, making it hard to diagnose. It can be fatal without early, appropriate management.

Neonatal infective endocarditis (IE) is an exceedingly rare disease and usually not associated with cardiac rhabdomyomas or any underlying structural cardiac anomalies. Cardiac rhabdomyoma is also the most common benign primary cardiac tumor. The prognosis depends on the size, location of tumors, and outflow tract obstruction but can regress within 2 months of age and reduces the necessity of surgery. Due to the variable clinical features and course, we need to evaluate cardiac vegetation as soon as possible for better outcomes. A combination of these two conditions was not reported before. Here, we presented a case of IE with cardiac rhabdomyoma in a male baby which is first reported from Bangladesh previously.

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