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Myocarditis leading to severe dilated cardiomyopathy in a patient with dengue Fever.

Tahir H, Daruwalla V, Hayat S - Case Rep Cardiol (2015)

Bottom Line: Patient condition worsened and he got admitted to the ICU because of acute hypoxic respiratory failure.Despite aggressive measures, patient died on day 5.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Conemaugh Memorial Hospital, 1086 Franklin Street, Johnstown, PA 15905, USA.

ABSTRACT
Background. Majority of dengue fever cases follow a benign self-limiting course but recently rare presentations and complications are increasingly seen due to rising burden of disease. Cardiac involvement in dengue fever with fatal outcome is a very rare complication. We report a case of 44-year-old patient who presented with symptoms of severe acute congestive heart secondary to myocarditis induced cardiomyopathy caused by dengue virus infection. Case Presentation. A 44-year-old man presented to ER with the complaints of high fever, fatigue, and shortness of breath. Patient was lethargic and blood pressure was low when he was brought to the ER. CXR showed cardiomegaly with pulmonary congestion and echocardiography revealed dilated left ventricle and ejection fraction of 10%. Patient condition worsened and he got admitted to the ICU because of acute hypoxic respiratory failure. Despite aggressive measures, patient died on day 5. Conclusion. Dilated cardiomyopathy is a rare complication of dengue myocarditis. Early recognition of acute DCM caused by dengue myocarditis is imperative in the management of dengue fever as early detection and management of cardiac failure can improve the survival of patient.

No MeSH data available.


Related in: MedlinePlus

EKG shows normal sinus rhythm with frequent premature ventricular complexes (Arrows).
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fig1: EKG shows normal sinus rhythm with frequent premature ventricular complexes (Arrows).

Mentions: Patient was suspected to have dengue shock syndrome and was immediately admitted on floor and resuscitated with IV fluids. Antiemetics and Tylenol was also given. Routine EKG was done which showed sinus rhythm and frequent premature ventricular contractions (PVC) with no ST or T wave ischemic changes (Figure 1). CXR showed bilateral interstitial edema, cardiomegaly, and pleural effusion in both lungs (Figure 2). The X-ray findings were suggestive of acute congestive heart failure. Elevated BNP (1040) supported the X-ray findings His haematological investigations revealed slight thrombocytopenia (127000), leucopenia (3100), and haemoglobin of 12. Cardiac enzymes were initially slightly elevated but remained stable over the course of hospital stay (Table 1). Urgent transthoracic echocardiography was done which showed ejection fraction of 10% and left ventricle dilation without focal wall motion defect and or focal thinning (Figure 3). Cardiac catheterization revealed EF of 13% and normal coronary arteries (Figure 4). Patient was started on dobutamine infusion along with ACEIs, spironolactone, and Lasix. Blood cultures, ESR, hepatitis panel, thyroid profile, and urine drug screen were all within normal limits. Malarial antigen test and typhoid serology were also negative. Anti-dengue IGM by ELISA was negative at the time of admission but was positive for IGG antibodies at that time. Repeat testing on day 3 showed positive IGM antibodies for dengue. The diagnosis was confirmed with reverse transcriptase polymerised chain reaction (RT-PCR) which was positive for dengue virus serotype 3 (DEN-3). In view of above clinical scenario with positive dengue serology, history of myocarditis during primary dengue infection 1 year ago, and echocardiographic findings, diagnosis of dengue virus induced dilated cardiomyopathy (DCM) was made. Fulminant myocarditis with acute myocardial failure was ruled out as cardiac enzymes were almost normal in the setting of dilated cardiac chambers on Echo.


Myocarditis leading to severe dilated cardiomyopathy in a patient with dengue Fever.

Tahir H, Daruwalla V, Hayat S - Case Rep Cardiol (2015)

EKG shows normal sinus rhythm with frequent premature ventricular complexes (Arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4352732&req=5

fig1: EKG shows normal sinus rhythm with frequent premature ventricular complexes (Arrows).
Mentions: Patient was suspected to have dengue shock syndrome and was immediately admitted on floor and resuscitated with IV fluids. Antiemetics and Tylenol was also given. Routine EKG was done which showed sinus rhythm and frequent premature ventricular contractions (PVC) with no ST or T wave ischemic changes (Figure 1). CXR showed bilateral interstitial edema, cardiomegaly, and pleural effusion in both lungs (Figure 2). The X-ray findings were suggestive of acute congestive heart failure. Elevated BNP (1040) supported the X-ray findings His haematological investigations revealed slight thrombocytopenia (127000), leucopenia (3100), and haemoglobin of 12. Cardiac enzymes were initially slightly elevated but remained stable over the course of hospital stay (Table 1). Urgent transthoracic echocardiography was done which showed ejection fraction of 10% and left ventricle dilation without focal wall motion defect and or focal thinning (Figure 3). Cardiac catheterization revealed EF of 13% and normal coronary arteries (Figure 4). Patient was started on dobutamine infusion along with ACEIs, spironolactone, and Lasix. Blood cultures, ESR, hepatitis panel, thyroid profile, and urine drug screen were all within normal limits. Malarial antigen test and typhoid serology were also negative. Anti-dengue IGM by ELISA was negative at the time of admission but was positive for IGG antibodies at that time. Repeat testing on day 3 showed positive IGM antibodies for dengue. The diagnosis was confirmed with reverse transcriptase polymerised chain reaction (RT-PCR) which was positive for dengue virus serotype 3 (DEN-3). In view of above clinical scenario with positive dengue serology, history of myocarditis during primary dengue infection 1 year ago, and echocardiographic findings, diagnosis of dengue virus induced dilated cardiomyopathy (DCM) was made. Fulminant myocarditis with acute myocardial failure was ruled out as cardiac enzymes were almost normal in the setting of dilated cardiac chambers on Echo.

Bottom Line: Patient condition worsened and he got admitted to the ICU because of acute hypoxic respiratory failure.Despite aggressive measures, patient died on day 5.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Conemaugh Memorial Hospital, 1086 Franklin Street, Johnstown, PA 15905, USA.

ABSTRACT
Background. Majority of dengue fever cases follow a benign self-limiting course but recently rare presentations and complications are increasingly seen due to rising burden of disease. Cardiac involvement in dengue fever with fatal outcome is a very rare complication. We report a case of 44-year-old patient who presented with symptoms of severe acute congestive heart secondary to myocarditis induced cardiomyopathy caused by dengue virus infection. Case Presentation. A 44-year-old man presented to ER with the complaints of high fever, fatigue, and shortness of breath. Patient was lethargic and blood pressure was low when he was brought to the ER. CXR showed cardiomegaly with pulmonary congestion and echocardiography revealed dilated left ventricle and ejection fraction of 10%. Patient condition worsened and he got admitted to the ICU because of acute hypoxic respiratory failure. Despite aggressive measures, patient died on day 5. Conclusion. Dilated cardiomyopathy is a rare complication of dengue myocarditis. Early recognition of acute DCM caused by dengue myocarditis is imperative in the management of dengue fever as early detection and management of cardiac failure can improve the survival of patient.

No MeSH data available.


Related in: MedlinePlus