Myocarditis Leading to Severe Dilated Cardiomyopathy in a Patient with Dengue Fever

Abstract

Background. Majority of dengue fever cases follow a benign self-limiting course but recently rare presentations and complications are increasingly seen due to rising burden of disease. Cardiac involvement in dengue fever with fatal outcome is a very rare complication. We report a case of 44-year-old patient who presented with symptoms of severe acute congestive heart secondary to myocarditis induced cardiomyopathy caused by dengue virus infection. Case Presentation. A 44-year-old man presented to ER with the complaints of high fever, fatigue, and shortness of breath. Patient was lethargic and blood pressure was low when he was brought to the ER. CXR showed cardiomegaly with pulmonary congestion and echocardiography revealed dilated left ventricle and ejection fraction of 10%. Patient condition worsened and he got admitted to the ICU because of acute hypoxic respiratory failure. Despite aggressive measures, patient died on day 5. Conclusion. Dilated cardiomyopathy is a rare complication of dengue myocarditis. Early recognition of acute DCM caused by dengue myocarditis is imperative in the management of dengue fever as early detection and management of cardiac failure can improve the survival of patient.

<p>Effects of triptolide and methotrexate nanosuspensions on left ventricular remodeling in autoimmune myocarditis rats</p>

“…1 Except for genetic factors, recently, myocarditis (ecology virus infection or autoimmune inflammation) caused by DCM has attracted much attention. 2,3 Myocarditis is a myocardial inflammatory disease and it is characterized by the degeneration, necrosis, and apoptosis of cardiomyocytes which also demonstrates inflammatory cell infiltration and myocardial interstitial remodeling. The activation of nuclear factor (NF)-κB signaling and the production of inflammatory cytokines (such as tumor necrosis factor [TNF]-α; IL-6, IL-1, IL-2, IL-4, and IL-10; monocyte chemoattractant protein [MCP]-1; interferon [IFN]-γ, etc) are the main factors for myocarditis.…”

Beyond thrombocytopaenia, haemorrhage and shock: the expanded dengue syndrome

“…A prospective study carried out in China during an outbreak has shown that the prognosis of dengue patients with or without myocarditis did not differ [26]. However, there have been several case reports which have reported fatal outcomes in patients with dengue myocarditis [24,[27][28][29][30][31]. A significant positive association between myocarditis and the severity of dengue has been shown in one study [26].…”

“…Summary of studies providing data on atypical manifestations of dengue. Sheetal et al[8], Neeraja et al[25], Li et al[26], Miranda et al[32] Nigam et al[9],Navinan et al[10], Virk et al[11], Dhariwal et al[12] 15% Khongphatthanayothin et al[5], Kirawittaya et al[20], Yacoub et al[21], Wali et al[22], Neeraja et al[25], Li et al[26] Miranda et al[24], Marques et al[27], Tahir et al[28], Sane et al[29],Ku et al …”

Miocarditis en la infección viral del dengue en pediatría.

“…La posibilidad de miocardiopatía dilatada inducida por DENV debe siempre tenerse en cuenta si un paciente tiene DENV y choque refractario, asociado a signos y síntomas de insuficiencia cardíaca congestiva. Se debe enfatizar de nuevo en que la detección temprana, la reanimación in-mediata, la clasificación del paciente, evitando la sobrecarga con líquidos intravenosos, son medidas cruciales para salvar vidas y puede mejorar la supervivencia de los pacientes [51]. Debe generarse conciencia, sospecha y atención de apoyo en la consecución de resultados positivos y benignos en estos pacientes [44].…”