These days, patients with Dengue present with atypical features.

After a few days of fever, ARF (Acute renal failure), altered liver enzymes, ARDS are very common presentations.

Most of patients do not present with body pain or low platelets or bleeding manifestations.

The most surprisingly, there is a normal platelet count in CBC, TLC slightly high/normal, Bilateral haziness in CXR, renal impairment, and Trop I markedly elevated, but there are nonspecific changes in ECG.

In this case, the patient’s condition may become critical as soon as ecosprin or clopidogrel, or claxane is commenced on suspicion of NSTEMI.

At this time, if any patient comes with fever whose trop I is elevated but a significant or non-significant change in ECG (like sinus bradycardia, poor R wave progression) – we should exclude DENGUE MYOCARDITIS and should not prescribe any Anti platelet without confirming Dengue Antibodies.

More interesting information – Pro BNP is high in these patients, and CVP is also high, which you may think that right atrial pressure is high! This report will encourage you to fluid restriction

But these may be the features of viral myocarditis.

In this case, you have to take care of Hb count or PCV in simple CBC (If it increases, you will understand that the patient is experiencing hemoconcentration due to cellular dehydration! Fluid should be given to the patient though CVP is high.

It is very likely that the dengue virus has acquired a new strain / or is changing the core antigen with success, invisibly!

So, all our doctors need to be a little cautious about Dengue myocarditis, especially patients coming with fever + elevated trop I.

Dr. Asif-Ur-Rahman

FRCEM (Final Part-UK)
Member – The Royal College of Emergency Medicine – RCEM UK, BCPS, ACCP.
Consultant –National Institute of Neuroscience (NINS)
Dhaka, Bangladesh.

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