Fulminant myocarditis-associated expanded dengue syndrome in pregnant woman: a case report

Abstract Background Dengue fever is a mosquito-borne viral disease whose incidence has increased globally, with Indonesia as hyperendemic. In Indonesia, around 17.4% of febrile cases were due to dengue. Expanded dengue syndrome is a term for dengue fever with atypical manifestations in other organs such as renal, respiratory, and cardiac. Dengue myocarditis remains underdiagnosed and usually has a low risk of heart failure. However, pregnancy increases the risk of expanded dengue syndrome, with the incidence six times higher in pregnant women. Due to limited studies about myocarditis treatment during pregnancy, it is critical to understand the effects of heart drugs and the importance of treatment choices with limited selection during fulminant myocarditis. Case presentation We reported a case of an adult pregnant woman in her second trimester with fulminant myocarditis-associated expanded dengue syndrome based on criteria. The patient suddenly worsened with progressive cardiomegaly and lung edema accompanied by cardiogenic shock. Multidisciplinary treatment management has been given to improve cardiac function and other organs due to dengue by considering the risk and family consent. The patient recovered from myocarditis, and the cardiac size has reduced. Conclusions Fulminant myocarditis is a serious complication of expanded dengue syndrome, and aggressive therapy is required to prevent it. Further investigations and a multidisciplinary system are required to reduce or minimize fetal abnormalities.