I appreciate Viroj Wiwanitkit comments on our recently published paper: “Histologic and Angiographic Imaging of Acute Shock Dengue Myocarditis”.1 I would like to emphasize a couple of points:
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In this case, dengue shock was treated with intravenous fluids and norepinephrine to maintain tissue perfusion, which could not have been achieved with intravenous fluids alone.
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The acute myocarditis appeared on the eighth day of admission and was treated in phase 1 of myocarditis (viral replication) with antiviral therapy (etiologic treatment) and methylprednisolone, avoiding autoimmune inflammatory myocardial damage (phase 2). This management prevented permanent myocardial damage (phase 3) and eventual death.2 Spontaneous remission has previously been reported,3 and therefore we cannot be sure whether this would have occurred in our patient or whether our treatment really changed natural course of disease.