Dengue Shock Syndrome with Unusual Cardiac Manifestation in a Child: A Case Report

Introduction: Dengue fever is a viral infectious disease transmitted through arthropods (arboviruses) that is most common throughout the world with the greatest burden occurring in tropical and subtropical regions. The clinical manifestations of dengue infection range from asymptomatic to severe dengue. Neutofil to lymphocyte ratio (NLR) was reported can predict the severity of myocarditis and the severity of dengue infection in children. Cardiac involvement in dengue patients has been reported in some cases and may be characterized by abnormal heart rhythms. Case Presentation: We describe the case of an 11-year-old patient with dengue shock syndrome and cardiac manifestation. The patient was given fluid therapy according to WHO guidelines for dengue shock syndrome and supportive treatment. In the convalescence phase, ECG examinations were carried out and the results showed sinus bradycardia and premature atrial complex. NLR was also found to increase in the early phase and decrease with the convalescence phase. The patient had no clinical manifestation of myocarditis, dyspnea or chest pain so there were no additional treatments for this condition. After four days of treatment, the patient was discharged from the hospital with an improved condition. Conclusion: Cardiac involvement can occur in dengue shock syndrome which can be characterized by abnormal cardiac rhythm on the ECG. NLR is a laboratory parameter that can be used as a predictor of the severity of dengue and myocarditis. Early diagnosis, supportive management and close monitoring with clinical and a laboratory parameter can reduce the mortality of dengue shock syndrome with cardiac manifestation in pediatric patients.