Letter to the editor Acute Shock Dengue Myocarditis

To the Editor,

The recent report on acute shock dengue myocarditis is of great interest. Guadalajara-Boo et al¹ report this finding in a case of dengue. In fact, fatal dengue myocarditis due to a dengue virus-induced cardiac lesion was reported a few years ago.² An interesting question concerns the increased severity of the disease. According to the previous report from a highly endemic area, Thailand, dengue myocarditis is rare but is not fatal.³ This observation has many possible explanations. Basic fluid management is the key therapeutic strategy for any dengue case and proper management avoids severe complications.⁴ However, because cardiac complications of dengue seem to be a rare presentation, diagnosis can be delayed, resulting in high fatality.⁵ This problem can be seen in nonendemic areas with a new emerging dengue problem where physicians lack experience in the management of dengue. In addition, a remaining question is whether there are any genetic mutations in the dengue virus that may have increased its cardiac pathogenicity. Further research on this topic is required.