Treatment Dilemma in an Unusual Case of Dengue Fever with Cardiomyopathy and Nephropathy: A Case Report

Abstract

Dengue is a viral illness in humans caused by the bite of infected Aedes mosquitoes, mostly Aedes aegypti and also Aedes albopictus. There are four serotypes of the Dengue virus that cause infection in humans and may lead to a variety of complications. Myocarditis and cardiomyopathy can occur in several viral and non viral infections, increasing morbidity and mortality. Nephropathy may also arise in dengue fever, causing complications. The case presented here involved both complications, nephropathy and cardiomyopathy, posing treatment challenges in terms of altering fluid and electrolyte status, which hindered fluid therapy as fluid overload would be detrimental. However, the complications were reversible with the normalisation of echocardiography and urea and creatinine levels. Long-term follow-up is necessary to monitor cardiac and renal function, as some patients may progress to Chronic Kidney Disease (CKD). The patient presented with fever, headache, vomiting, and haematuria, along with signs of fluid overload. There was a past history of fever, and since both Immunoglobulin G (IgG) and IgM Dengue antibodies were positive, this may be a case of a second episode of dengue fever causing complications. This case report emphasises the diagnostic and treatment challenges in a dengue patient with cardiomyopathy and nephropathy, where excessive fluid replacement may increase morbidity and mortality. Additionally, long-term follow-up of these patients is necessary.