Fatal dengue shock syndrome complicated by anterior ST-elevation myocardial infarction in a young adult: a case report

Background: Dengue is a mosquito-borne viral illness, a common tropical disease with a wide clinical spectrum. Most infections are mild, but about 5% progress to severe dengue, which includes dengue hemorrhagic fever and dengue shock syndrome (DSS) with plasma leakage, bleeding, and multiple organ dysfunction syndrome. Cardiac involvement is known but often under-recognized in dengue. Cardiac involvement most often manifests as myocarditis; however, acute myocardial infarction (MI) is exceedingly rare. Case presentation: A previously healthy 27-year-old male with laboratory-confirmed dengue initially presented without warning signs. Despite supportive care, he developed profound thrombocytopenia, rising hematocrit, and hypotension within 72 hours, indicative of DSS. ECG revealed anterior ST elevation and elevated cardiac enzymes, confirming acute MI. Echocardiography showed regional left ventricular hypokinesia consistent with ischemia rather than myocarditis. Despite aggressive fluid resuscitation and vasopressor support in the intensive care unit, the patient developed refractory shock and cardiac arrest, resulting in death. Antiplatelet and anticoagulants were contraindicated due to severe thrombocytopenia, complicating MI management. Conclusion: This case, highlights an unusual yet fatal overlap of DSS and acute coronary syndrome. Research is needed to clarify the pathophysiology of thrombosis in dengue and to develop guidelines for managing acute coronary syndrome when dengue causes severe illness.