Diagnosis and Outcome of a Fulminant Case of Dengue Myocarditis

Dengue is a viral zoonotic disease found in tropical and subtropical countries and transmitted by arthropod vectors, primarily Aedes mosquitoes. Dengue manifestations vary, and reinfection can trigger severe disease, including myocarditis. Nonspecific symptoms and serologic cross-reactivity among flaviviruses make etiological diagnosis difficult.

A 21-year-old otherwise healthy woman presented with fever and cardiogenic shock requiring mechanical circulatory support after returning from Brazil. Dengue virus (DENV) serotype-2 antibodies were found, with evidence of prior DENV serotype-1 infection. The patient was treated supportively and eventually recovered full cardiac function.

Dengue is one of the fastest growing mosquito-borne illnesses globally and is caused by 1 of 4 virus serotypes. There is no specific treatment for the infection, and flavivirus antibody assays are highly cross-reactive, requiring plaque reduction neutralization assays or other specialized tests to differentiate flavivirus infections.

Dengue shock syndrome with myocarditis may require mechanical circulatory support but carries a good prognosis for recovery.