Tragic homecoming: fatal dengue-induced myocarditis in a Maldives vacationer: a case report

Background Dengue fever is a viral disease considered an anthropoid-borne infection. The responsible virus is called dengue virus with four main subtypes (DENV-1 to DENV-4). The transmitting anthropoid is the Aedes mosquito (aegypti or Albopictus). The disease is endemic in tropical and subtropical regions, almost affecting 50–100 million people annually. The disease varies from flu-like illness in part of cases to more severe forms such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The incidence of cardiac involvement is also variable. Myocarditis and arrhythmia are the main forms of cardiac involvement. Myocarditis can occasionally cause severe cardiac dysfunction, requiring early detection and intervention. Case presentation A 46-year-old male with no history of cardiovascular diseases or any other systemic illnesses was admitted to the hospital in a state of cardiogenic shock a few days after returning from a vacation in the Maldives. Symptoms started 1 week after returning, within the typical incubation period of dengue virus. He had undergone aggressive treatment including veno-arterial extracorporeal membrane oxygenation (VA-ECMO), intra-aortic balloon pump (IABP), and amine therapy. Unfortunately, his condition deteriorated and he died after 12 days of hospitalization due to multiple organ failure. Autopsy findings revealed T-cell predominant lymphocytic myocarditis, pulmonary edema, diffuse bilateral pulmonary hemorrhage, pleural effusion, and retroperitoneal hemorrhagic infiltration. Conclusion This report turns on the light about a rare case of dengue myocarditis which was confirmed by autopsy. The case highlights the importance of early diagnosis and proper management of a rare but fatal complication of dengue infection. Due to the limited data about its incidence and prognosis, it is important to raise awareness in clinical practice, especially in endemic regions.