Dilated cardiomyopathy is a rare complication of dengue myocarditis, early diagnosis is imperative in the management of dengue fever and improves the survival of the patient.

  • Cardiac involvement in dengue viral fever with fatal outcome was thought to be a very rare complication.
  • A 44-year-old male patient had presented severe acute congestive heart secondary to dengue myocarditis induced cardiomyopathy.
  • The patient had a history of hypertension and tuberculosis, and also earlier dengue fever.
  • Dengue myocarditis patients are mostly asymptomatic or have vague symptoms and the diagnosis is easily missed.
  • Hence possible and non confirmed myocarditis during primary infection might have led to dilated cardiomyopathy over the course of time, and presented acute congestive heart failure with the secondary dengue infection in this patient.
  • As clinical examination did not present any ischemic or other cardiac conditions, he was treated for conventional heart failure treatment.
  • But the patient did not show any response to the treatment and was positive for dengue virus, also developed severe dengue haemorrhagic fever.
  • Despite of aggressive measures, patient died within a week.

Clinical presentations:

  • High fever, fatigue, shortness of breath, lethargic and lowered BP.
  • Myalgias, frontal headache, and generalized weakness, exercise intolerance, mild paroxysmal nocturnal dyspnea and orthopnea.
  • Chest X-ray showed cardiomegaly with pulmonary congestion.
  • The patient denied any chest pain, palpitations, cough, or syncope.
  • Echocardiography: dilated LV, EF less than 10%.
  • EKG: widespread T wave inversions.
  • But the patient denied any diabetes, ischemic heart disease or hyperlipidemia.
  • Vital signs in emergency room: BP (89/52 mmHg), temperature (103 F, heart rate (116/min), and respiratory rate (19).
  • Admitted to ICU for acute hypoxemic respiratory failure.

Thus early diagnosis of dilated cardiomyopathy caused by dengue myocarditis is imperative in the management of dengue fever and improves the survival of the patient.

Citation
Tahir et al. Myocarditis Leading to Severe Dilated Cardiomyopathy in a Patient with Dengue Fever. Case Reports in Cardiology. Volume 2015 (2015), Article ID 319312, 4 pages.

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