A case presentation of a fatal dengue myocarditis showing evidence for dengue virus-induced lesion.
Dengue is a prevalent arthropod-borne viral disease in tropical and subtropical areas of the globe. Dengue clinical manifestations include asymptomatic infections; undifferentiated fever; dengue fever, which is characterized by fever, headache, retroorbital pain, myalgia, and arthralgia; and a severe form of the disease denominated dengue haemorrhagic fever/dengue shock syndrome, characterized by haemoconcentration, thrombocytopenia, and bleeding tendency. However, atypical manifestations, such as liver, central nervous system, and cardiac involvement, have been increasingly reported. We report an atypical and rare presentation of dengue disease marked by a dramatic and fatal cardiogenic shock due to acute myocarditis. Histopathological analysis of heart tissue showed several multifocal areas of muscle necrosis and intense interstitial oedema associated with clusters of virus particles inside the cardiomyocytes and in the interstitial space, providing evidence of a possible direct action of dengue virus on myocardium.
University of São Paulo Medical School at Ribeirão Preto, São Paulo, Brazil.
Carlos Henrique
CH
Miranda
Marcos de Carvalho
Mde C
Borges
André
A
Schmidt
Antônio
A
Pazin-Filho
Marcos Antônio
MA
Rossi
Simone Gusmão
SG
Ramos
Benedito Antônio
BA
Lopes da Fonseca
D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D009205:Myocarditis / Q000821:virology*; D019595:Severe Dengue; D012770:Shock, Cardiogenic / Q000821:virology*
Acute heart failure; acute myocarditis; cardiogenic shock; dengue fever