Dengue infection is one of the most important communicable disease in tropical countries and it shows a rise in the number of incidence in recent years, including Malaysia. There is no specific treatment for dengue, but medical care by experienced physicians has shown to reduce mortality. Still, treating dengue remains a challenge due to its dynamic clinical course even more so in those who have comorbidities.
We report a case of an elderly woman with underlying ischaemic heart disease who presented with dengue fever at day 3 of illness and simultaneously has been having typical angina pain for few days prior to presentation. She had no warning signs, her vital signs were stable, and physical examinations were unremarkable. The ECG showed ST depression in V2-V6. Her laboratory values revealed haemoglobin level of 14.7g/dl, white blood cell: 7.9 x 103 /uL, platelet: 143 x103 /uL and haematocrit: 41.5% and positive NS1 antigen. Diagnosis of dengue fever at day 3 of illness and acute coronary syndrome were established and patient was served with single dose of double antiplatelet and anticoagulant in ED but it was discontinued in ward. Patient developed intracranial bleed in ward at day 7 of illness and she succumbed to death at day 8 of illness after the intracranial bleed worsen noted from a repeated CT scan.
There is no clear recommendations of antiplatelet in dengue, but some literature has shown that antithrombotic was given in dengue patients and patients with thrombocytopenia with diligent monitoring. In general, they propose on avoidance of antiplatelet, but the management is case to case basis and to balance between the benefit and risk. Equally important is consensual agreement among interdepartmental while managing dengue patients for the utmost benefit of patient.
antiplatelet, dengue, acute coronary syndrome