A fatal case of cerebral oedema and myocarditis associated with secondary dengue infection

Saw Kian Cheah, Raha Abdul Rahman, Aliza Mohamad Yusof, Tang Suet Ping Shereen, Kamal Bashar Abu Bakar

Research output: Contribution to journalArticle

Abstract

Background: Secondary dengue infection (SDI), in the form of two sequential infections by different serotypes, will lead to severe dengue. Concomitant organ failure in particular cardiovascular (CVS) and central nervous system (CNS) carries further rise in the mortality rate. Case report: We report a confirmed SDI in a 27-year-old man who presented with hypovolemic shock due to persistent vomiting and diarrhoea. He was stabilized after fluid resuscitation. However, he developed sudden onset of seizure and myocarditis with unstable haemodynamic thereafter. After stabilization, his gag and cough reflexes were absent with dilated pupils. Imaging of the brain showed extensive cerebral oedema with poor flow beyond the internal carotid arteries and its branches above circle of Willis. He remained comatose with subsequent complications of diabetes insipidus, secondary. bacterial infection, and acute kidney injury. He passed away after 19 days of admission. Discussion: There is a higher risk of severe dengue with SDI as it is associated with antibodydependent enhancement (ADE) mechanism. The pre-existing dengue antibodies enhance virus replication by activating memory T-cells causing surges in inflammatory cytokines. The increased capillary permeability with massive vascular leak most likely led to the extensive cerebral oedema in this patient. The concomitant cardiovascular failure also led to his irreversible outcome. Conclusion: Severe cardiovascular and neurological manifestations can occur in SDI with resultant in the fatality. Therefore, early recognition of risk factors in the early phase of severe dengue is important to prevent the irreversible outcome.

Original languageEnglish
Pages (from-to)46-51
Number of pages6
JournalCritical Care and Shock
Volume20
Issue number2
Publication statusPublished - 2017

Fingerprint

Dengue
Brain Edema
Myocarditis
Coinfection
Severe Dengue
Circle of Willis
Abnormal Reflexes
Diabetes Insipidus
Capillary Permeability
Internal Carotid Artery
Pupil
Coma
Virus Replication
Neurologic Manifestations
Bacterial Infections
Acute Kidney Injury
Cough
Neuroimaging
Resuscitation
Vomiting

Keywords

  • Antibody-dependent enhancement
  • Dengue encephalopathy
  • Myocarditis
  • Secondary dengue infection
  • Severe dengue

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

A fatal case of cerebral oedema and myocarditis associated with secondary dengue infection. / Cheah, Saw Kian; Abdul Rahman, Raha; Yusof, Aliza Mohamad; Shereen, Tang Suet Ping; Bakar, Kamal Bashar Abu.

In: Critical Care and Shock, Vol. 20, No. 2, 2017, p. 46-51.

Research output: Contribution to journalArticle

Cheah, Saw Kian ; Abdul Rahman, Raha ; Yusof, Aliza Mohamad ; Shereen, Tang Suet Ping ; Bakar, Kamal Bashar Abu. / A fatal case of cerebral oedema and myocarditis associated with secondary dengue infection. In: Critical Care and Shock. 2017 ; Vol. 20, No. 2. pp. 46-51.
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