Gossip, Lies And Reelin

Dengue can on occasions present with atypical presentations like acute abdominal pain, diarrhea, severe GI bleed, severe headache, convulsions, altered sensorium, encephalitis, intracranial hemorrhage, irregular pulse or heart rate, severe respiratory distress, fulminant hepatic failure, obstructive jaundice, acute renal failure, disseminate intravascular coagulation [3]. A Entinostat manufacturer number of patients also manifest symptoms and sign that are not commonly seen and close monitoring in these cases is required. Among the rare cardiac manifestations atrial fibrillation, type 1 AV block, myocarditis have been reported. Type 2 AV block during dengue illness has not been reported till date [4�C7]. In our patient causes of reversible AV block like hyperkalemia, hypermagnesimia, hypothyroidism, drug history were ruled out. As patient was not having history of any chronic illness and had recovered completely on the conservative management chances of other infectious disease like Tuberculosis, Lyme��s disease, Chaga��s disease, Syphilis, were ruled out and it was concluded that the block was due to dengue illness that could have produced some kind of conduction abnormality in the AV node [8]. Therefore, extensive clinical and experimental studies are required to understand the pathological mechanism of AV node dysfunction. Cardiac arrhythmias in patients of dengue fever are seen in cases of myocarditis and have lead to episodes of syncope and even sudden death therefore careful monitoring and evaluation of conduction abnormality is must during the illness [9]. In a case series reported by Wali et al., the mean ejection fraction was 47.06% in patients with dengue hemorrhagic fever and was 39% in patients with dengue shock syndrome. They also reported multiple ST and T wave changes in ECG which reverted back to normal within 3 months of follow-up along with ejection fraction [10]. Mobitz type 1 AV block has been reported by Khongphatthallayothin et al., from Thailand during the recovery phase of Dengue fever [11]. Sharma et al., reported variable atrio-ventricular block in an 18-year-old male with dengue fever who developed Mobitz type 1 AV block and AV dissociation that had a spontaneous resolution [12]. Our patient had Mobitz Type 2 AV block and recovered completely on third day and shows that dengue illness can cause reversible conduction abnormality in the AV node. Conclusion Mobitz Type II AV block in Dengue Hemorrhagic Fever can be benign and careful monitoring alone in these patients may suffice. Awareness about this condition and its course may prevent unnecessary evaluation and referral of these patients to tertiary centers.