• Carlos Henrique Miranda, Marcos de Carvalho Borges, André Schmidt, Antônio Pazin-Filho, Marcos Antônio Rossi, Simone Gusmão Ramos, and Benedito Antônio Lopes da Fonseca.
• University of São Paulo Medical School at Ribeirão Preto, São Paulo, Brazil.
• Eur Heart J Acute Cardiovasc Care. 2013 Jun 1;2(2):127-30.

AbstractDengue is a prevalent arthropod-borne viral disease in tropical and subtropical areas of the globe. Dengue clinical manifestations include asymptomatic infections; undifferentiated fever; dengue fever, which is characterized by fever, headache, retroorbital pain, myalgia, and arthralgia; and a severe form of the disease denominated dengue haemorrhagic fever/dengue shock syndrome, characterized by haemoconcentration, thrombocytopenia, and bleeding tendency. However, atypical manifestations, such as liver, central nervous system, and cardiac involvement, have been increasingly reported. We report an atypical and rare presentation of dengue disease marked by a dramatic and fatal cardiogenic shock due to acute myocarditis. Histopathological analysis of heart tissue showed several multifocal areas of muscle necrosis and intense interstitial oedema associated with clusters of virus particles inside the cardiomyocytes and in the interstitial space, providing evidence of a possible direct action of dengue virus on myocardium.

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