Dengue is an important mosquitoes-borne viral disease which is endemic in tropics and subtropics region. Rapid spreading of disease to previously unaffected region was found in recent years. Atypical manifestations, such as myocarditis, were reported during large outbreak. There is a wide range of clinical manifestations of cardiac involvement in dengue, but rarely fatal. Here we reported a case of fulminant dengue myocarditis in fatal outcome despite cardiac mechanical support.
Clinical manifestation of dengue ranges from self-limited fever to severe hemorrhagic manifestations and even shock syndrome. Cardiac involvement in the patients with dengue fever is not uncommon, but fatal outcome is rare. There is also limited report on using cardiac mechanical support. Here we reported a case of fatal dengue myocarditis despite cardiac mechanical support.
A 52-year-old woman was admitted to our emergency department (ED) on day 3 of chest pain. She had febrile episode and sore throat 5 days ago, followed by the development of chest discomfort, diaphoresis, nausea, and vomiting. The patient denied recent travel history. She had received operation for breast cancer and completed chemotherapy 10 years ago and was considered healthy otherwise.
On arrival at our ED, vital signs were body temperature, 36.6°C; pulse rate, 90 beats per minute; respiratory rate, 26 breaths per minute; and blood pressure, 103/66 mmHg. Laboratory data revealed white blood count cell, 3100/
While in intensive care, her hemodynamic status was unstable and required fluid resuscitation. Follow-up troponin-I was 6.5 ng/mL, series of EKG changes indicated acute myocardial infarction and acute pericarditis, and echocardiogram showed anteroseptal left ventricle hypokinesia with an ejection fraction (EF) of 34%. Cardioangiography was performed but revealed patent coronary arteries. However, the patient was in shock status. Arterial blood gas analysis showed severe metabolic acidosis (pH 6.917, base excess −27.2) and lactate was 18.6 mmol/L. She received endotracheal intubation for respiratory support. Intra-aortic balloon pumping (IABP) and extracorporeal membrane oxygenation (ECMO) were implanted for hemodynamic support as poor response of 3 vasopressors. Initial blood cultures revealed negative results. Serum dengue virus-real-time PCR (The Applied Biosystems® StepOnePlus™) showed positive in the second day. Other titers of
Several dengue infection outbreaks have recently been reported in Taiwan, especially at southern Taiwan [
Clinical manifestations of dengue myocardial involvement range from mild elevation of biomarkers to myocarditis and even pericarditis [
In conclusion, new treatment strategy for fulminant dengue myocarditis is needed in the future especially in the era of increasing spread of dengue disease.
The authors declare that there is no conflict of interests regarding the publication of this paper.