Severe Dengue Presenting as Acute Myocardial Infarction in a Young Patient: A Case Study

Abstract

Background: Dengue virus infection is a worldwide arboviral hazard that is typically characterized by fever, aches, and, possibly, excessive plasma loss and blood loss. Though subclinical cardio-involvement is a frequent occurrence, it is a noteworthy and daunting clinical challenge to manifest in a syndrome so indistinguishable with acute myocardial infarction (MI). The case highlights the important overlap between cardiology and infectious disease.

Case Presentation: A 32-year-old previously well male patient, having lived all his life in an area with endemic dengue, presented with acute crushing chest pain, electrocardiogram (ECG) showing ST-segment elevation in anteroseptal leads, and a highly elevated high-sensitivity cardiac troponin I level (15.2 ng/mL), which meet the diagnostic criteria of ST-elevation MI (STEMI). He has given a recent history of febrile disease. Physical evaluation demonstrated relative bradycardia and lab results were important in terms of thrombocytopenia and leukopenia. An increase in positive dengue NS1 antigen was a sign of acute infection. Emergency coronary angiography showed normal coronary arteries, which exclude the possibility of atherosclerotic disease. The eventual diagnosis was severe dengue myocarditis and faking STEMI. The management was changed to supportive care and the symptoms were completely resolved and the cardiac function started recovering significantly.

Conclusions: The case demonstrates that dengue virus may lead to the development of a severe acute syndrome of myocardial injury that is clinically similar to STEMI. There is a great possibility of overdiagnosis and unnecessary anticoagulation or invasive coronary surgery, and this could prove detrimental in the backdrop of thrombocytopenia and a systemic viral disease. In young, endemic, patients who have STEMI-like manifestations and a febrile prodrome, greater clinical suspicion of dengue myocarditis is urgent. Coronary angiography is the gold standard of a definitive diagnosis and appropriate and possibly life saving management.