Y. M. Adrian*, L.T. Ratana**, and T. M. Waly***

*Waled General Hospital, Cirebon, West Java, Indonesia,

**Dustira Army Hospital, Bandung, West Java, Indonesia,

***Waled General Hospital, Cirebon, West Java, Indonesia

Background:

Dengue is one of the most important mosquito-borne viral diseases with many complications. Dengue myocarditis is a very rare complication of dengue fever.Their non-specific signs and symptoms make early diagnosis hard to proceed. We are reporting a case which the patient presented as dengue myocarditis masquerades as acute myocardial infarction.

Case Report:

A 55-year-old woman was suffering from intermittent fever and acute chest pain for several days. She had history of fever, nausea, vomiting, myalgia and athralgia. Her son recently discharged from hospital due to dengue fever. Multiple petechiae found on legs. Cardiac examination revealed a third heart sound. She had bilateral basal crackles on pulmonary examination. Hepatomegaly and tenderness on epigastric area were found. Rumple leed was positive. Patient’s laboratory data show abnormal level of cardiac biomarker, platelet count, liver enzymes, ureum, creatinine, albumin, potassium. Blood test was positive Dengue IgG and IgM antibodies. Electrocardiogram show ST-segment elevation leads V1–V4. Chest radiography disclosed pulmonary congestion and cardiomegaly. Therefore, she was diagnosed as ST-elevation myocardial infarction, heart failure, chronic kidney disease and severe dengue. Intravenous fluid supplementation, vasopressor, methylprednisolone, anticoagulant, nitrates and low dose antiplatelet were given to the patient. PPI, anti emetic, bicarbonate, oxygen, albumin and furosemide were also given as supportive medications. The patient’s clinical status improved subsequently.

Discussion:

With positive dengue serology, raised cardiac markers and electrocardi-ography findings which improved on convalescence, a diagnosis of dengue myocarditis was made rather than acute MI. This case reminds physicians that myocarditis can complicate from dengue fever, and the electrocardiography changes can mimic acute MI. Even though patient presents with acute chest pain and features of acute MI, if patient has had other history and clinical features suggestive of dengue fever; myocarditis must be considered before starting treatment for acute MI.

Keywords: myocarditis, dengue,

Note: abstract copied as written in European Heart Journal Supplements (2017) 19 (Supplement E), E53-E73