Child with fulminant dengue myocarditis survived by ECMO support

Like many other infections, Dengue is known to cause myocarditis. Dengue myocarditis can be mild or fulminant. Fulminant myocarditis can rapidly lead to end organ damage and even death. We present here an adolescent girl suffering from Dengue infection who developed fulminant myocarditis. Myocarditis was diagnosed by presence of low left ventricular ejection fraction, shock and elevated cardiac enzymes. When she developed refractory shock (unresponsive to preload optimization, inotropes, positive pressure ventilation, colloids, myocardial protective strategies, Intravenous immunoglobulins etc.), she required emergency Veno-arterial ECMO (Extra Corporeal Membrane Oxygenation) support. On 6th day, as her condition improved, she was weaned from the ECMO. Echocardiography on follow up shows normal study and she is leading a normal life today. Hence, for patients with refractory shock caused by Dengue myocarditis, timely referral to higher centre with Extra-corporal life support facility should be considered.