ABSTRACT

Background : Dengue virus is transmitted by the Aedes aegypti mosquito. Dengue may remain asymptomatic or manifest a dengue fever (DF), dengue hemmorhagic fever (DHF), dengue shock syndrome (DSS). However, atypical manifestations such as liver, central nervous system and cardiac involvement have been increasingly reported and called expanded dengue syndrome. One of the cardiac complications is myocarditis. Case : A 18-year-old woman complains of high fever since 3 day, epistaxis, chest pain, dyspnea and vomiting. Laboratory examination obtained trombocytopenia, hemoconcentration, NS1, IgG-IgM dengue positive and CKMB, Troponin-I increase. Electrocardiogram result ischemic anterior-posterior. Echocardiography results hyperechogenic on miocard suspicious a myocarditis. Based on data, the patient was diagnosed with acute myocarditis and dengue hemmorhagic fever grade II. Condition improved after five days of treatment. Discussions : Cardiac complications in dengue fever, previously thought very rare, are now increasingly observed. Myocarditis is the most common cardiac manifestation in dengue fever. The main mechanism of dengue myocarditis is still unknown though both direct viral infection and immune mediated damage have been suggested to be the cause of myocardial damage. The low incidence of dengue myocarditis is because it’s asymptomatic or have vague symptoms and diagnosis is easily missed. Studies showed that almost all cases of dengue myocarditis are self-limiting and severe myocarditis leading to dilated cardiomyopathy is extremely rare. Conclusion : There have been reported a patient with dengue hemorrhagic fever with manifestation myocarditis. Condition improve with supportive management.

Key words : Dengue, Myocarditis, Expanded Dengue Syndrome