Acute fulminant myocarditis in a case of dengue fever: A case report

Dengue fever is a potentially life-threatening vector-borne tropical disease caused by a single-stranded positive-sense ribonucleic acid virus belonging to the Flaviviridae family. Outbreaks have increased in severity over the past few years, especially in developing countries in South Asia[1]. While dengue fever is a self-limiting illness in the majority of patients, about 0.5% of patients develop a complicated course requiring specialised therapy[2]. A total of 20 000 deaths are reported annually worldwide due to complications associated with severe dengue fever[2]. Hypotension caused by intravascular depletion due to capillary leak is common in dengue hemorrhagic fever and dengue shock syndrome. However, myocardial dysfunction is also seen with dengue hemorrhagic fever/dengue shock syndrome and could be responsible for hypotension and shock[3]. Cardiac involvement in the form of decreased left ventricular performance[4] is known. Although isolated myocarditis has previously been reported in association with the disease, it is still rare. We reported a 5-year-old boy who presented with fulminant viral myocarditis due to dengue infection and died within 24 h. Biopsy of heart revealed lymphocytic infiltration.