We report the case of a 22-year-old male patient from Iquitos, Peruvian jungle, with no relevant history.
She had a four-day history of fever, chills, headache, epigastric pain and gingivorragia.
Physical examination showed a temperature of 37.5°C, blood pressure 110 mm Hg, and respiratory rate of 22 breaths per min. The rest of the examination showed no abnormalities.
The following day, vesicular strain was added, with no dyspnea at mid-term and dark red content stools, whose culture was negative; on physical examination, the lung presented a murmur decreased in the lower third heart sound.
Hematocrit was 48% and platelet count was 51,000/mm3.
Serology for dengue and leptospira was performed, resulting IgM for dengue positive.
Dengue diagnosis was confirmed with a second IgM sample.
Due to the onset of dyspnea, echocardiography and troponin were performed, which was positive and configuring the diagnosis of myocarditis.
A chest X-ray showed cardiomegaly with pleural effusion.
She was admitted to the Intensive Care Unit due to poor evolution and persistence of fever.
Due to respiratory failure and impaired consciousness (Glasgow 10), the patient was switched to invasive mechanical ventilation.
Among the auxiliary tests, arterial gases stood out: pH 7.52; pCO2 58 mmHg and PO2 (A-a) 368 mmHg, platelet count 157,000/mm3, hematocrit 43%, severe renal failure 167 mg/dl.
Treatment was initiated with ciprofloxacin, ceftazidime empirically, vitamin K and i.v. furosemide.
Two days later, the patient developed spontaneous ventilation and decreased edema.
Within the tests, troponin control was negative and creatinine within normal ranges.
A control echocardiography was performed one week later and was normal.
