Dengue myocarditis in Singapore: two case reports.

Area of Science:

• Cardiology
• Infectious Diseases
• Virology

Background:

• Dengue viral infection is a significant global health concern, primarily known for causing febrile illness and hemorrhagic complications.
• Cardiac involvement, specifically acute myocarditis, is an uncommon but serious manifestation of dengue infection.
• Understanding severe dengue presentations is crucial for timely diagnosis and management.

Observation:

• Two young adult males presented with complicated dengue viral infections complicated by acute myocarditis.
• One patient experienced chest pain and electrocardiographic changes indicative of myocardial depression, while the second rapidly deteriorated and demised.
• Histological examination of cardiac tissue revealed myocyte necrosis and lymphocytic infiltration, consistent with viral myocarditis.

Findings:

• Both cases met the World Health Organization (WHO) criteria for probable dengue.
• The first case showed positive dengue serology (IgM and IgG), and the second was PCR-positive for dengue serotype 2.
• Neither case fully met the criteria for dengue hemorrhagic fever (DHF), underscoring that severe cardiac complications can occur independently.

Implications:

• Acute myocarditis is a potentially fatal complication of dengue infection that requires clinical consideration.
• Early recognition and supportive care for cardiac dysfunction in dengue patients are critical.
• Further research into the mechanisms and prevalence of dengue-associated myocarditis is warranted.