Dengue Fever-Induced Complete Heart Block (Cardiac Dengue) Requiring Permanent Pacemaker Implantation in a 53-Year-Old Man: A Case Report

Dengue fever is an endemic mosquito-borne viral infection in many tropical and subtropical regions. While its common manifestations include high-grade fever, rash, and myalgia, cardiac complications, particularly complete heart block, are rare but potentially life-threatening, underscoring the importance of vigilance. A 53-year-old man with type 2 diabetes mellitus and hypertension presented with dizziness, weakness, and a five-day history of high-grade fever with chills. He lived in a dengue-endemic area and denied any recent travel. Physical examination revealed bradyarrhythmia (38-49 beats per minute) and hypotension (99/72 millimeters of mercury). Laboratory tests confirmed acute dengue infection. Despite supportive care and temporary pacing, the patient's intrinsic atrioventricular conduction showed no recovery, leading to persistent pacemaker dependence. On hospital day 17, a permanent dual-chamber pacemaker was implanted. He stabilized after the procedure and was discharged with close follow-up. The diagnosis of dengue was established using standard clinical criteria, confirmed by serologies for immunoglobulin M and immunoglobulin G and reverse transcription polymerase chain reaction. Comprehensive investigations excluded other bradyarrhythmia causes, such as Lyme disease, sarcoidosis, and myocarditis, supporting dengue as the sole etiology. This case highlights the rare but significant phenomenon of dengue-induced complete heart block, emphasizing that long-term pacemaker support may be necessary if conduction fails to recover. By adding to the limited data on dengue-associated advanced conduction disturbances, this case underscores the need for early recognition and multidisciplinary management to improve outcomes.