Abstract
A Common Fever with an Uncommon Presentation
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Dengue is a highly prevalent arthropod borne viral disease in tropical and subtropical areas of the globe. While majority of dengue cases are benign, rare presentations and complications are increasingly seen due to the rising burden of disease mainly in tropical developing countries. Dengue can manifest in a milder form with fever, headache, arthralgia on one end of the spectrum to a severe near-fatal illness with hemorrhagic disease and Dengue shock syndrome. While these entities are known, herein we report a case of dengue fever with a rare complication - acute myocarditis. A 46-year-old lady suffering from dengue fever developed acute heart failure with severe left ventricular dysfunction during her course of illness. Her hemodynamics worsened warranting inotropes and respiratory support. Coronary artery disease was ruled out by normal coronaries on angiogram thus raising the possibility of fulminant viral myocarditis. Cardiac MRI showed features of resolving myocarditis and this proves the severe myocardial involvement by the arbovirus. The patient recovered completely with improved systolic dysfunction after 10 days of supportive care. The reported literature on Dengue myocarditis is scarce because it's often under diagnosed due to the low index of suspicion. So, clinicians must be well aware of this complication due to its significant contribution to hemodynamic instability.
Keywords: Dengue, Acute myocarditis, Fulminant viral myocarditis, Coronary artery disease, Cardiac MRI
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