Associazione Nazionale Medici Cardiologi Ospedalieri



Dengue Myocarditis in a Deceased Patient with Postmortem Positive Dengue Serology

Petrone Alessio Firenze(Firenze) – Careggi | Minopoli TizianaCristina Firenze(Firenze) – Careggi | Di Mario Carlo Firenze(Firenze) – Careggi

Dengue, a viral illness, is spread through the bite of an infected female arthropod and is mostly found in tropical and subtropical areas. The disease can present in various forms: from silent, asymptomatic cases to the more recognizable dengue fever. In its severe manifestations, it can progress to hemorrhagic dengue or the more critical dengue shock syndrome. Additionally, there are uncommon presentations (known as expanded dengue syndrome) that include myocarditis.

Here, we present the case of a 50-year-old woman with a medical history of undifferentiated connective tissue disorder and breast carcinoma. Following a trip to Thailand in November 2023, she exhibited a three-day fever. She was admitted emergency department (DEA) on November 11 with syncopal episodes, nausea, vomiting, hypotension, peripheral hypoperfusion, and lactic acidosis. An ECG displayed QS patterns in V1-V3, and echocardiography indicated global hypokinesia (FE: 20%), a 5 mm pericardial effusion, and a non-collapsible IVC of 21 mm. In the suspicion of infective myocarditis, we performed serology testing for several viruses. Upon transfer to the intensive care unit (CICU), she presented with severe metabolic acidosis secondary to cardiogenic shock. Interventions included an intra-aortic balloon pump (IABP) and vasopressor support. Despite these measures, her condition deteriorated, necessitating extracorporeal membrane oxygenation (ECMO) initiation. Although intensive management, her clinical status did not improve. Serial laboratory analyses indicated ongoing multiorgan dysfunction. Unfortunately, the patient ‘s condition worsened, culminating in her demise on November 13. The serology analysis results, available after the patient ‘s death, revealed an infection caused by dengue virus.

In this case, we highlight a rare presentation of dengue virus infection leading to myocarditis. Despite aggressive therapeutic interventions, including ECMO support, the patient ‘s condition deteriorated rapidly, underscoring the severity of dengue myocarditis. The delayed diagnosis emphasizes the importance of increased clinical vigilance in endemic areas, especially when encountering unusual cardiac presentations in patients with recent travel histories to dengue-endemic regions.