Heart broken by a mosquito: An unusual case of Takotsubo syndrome

Pakistan has recently witnessed an epidemic of dengue infection and thereafter, certain various presentations of patients with dengue infection have been reported. The cardiac manifestation of dengue infection is primarily an inflammatory response to infection, however, dengue can rarely present as Takotsubo syndrome. Here, we report a the case of a 69‑year‑ old male, who presented with fever and ab‑ dominal pain and was diagnosed with dengue fever on serological workup. Just prior to being discharged, the patient developed acute chest pain, and dyspnoea with ST‑segment elevation in the anterolateral leads on electrocardiogram and raised cardiac biomarkers. An urgent coronary angiogram showed non‑obstructive coronary artery disease with apical ballooning on ventriculography. On the ba‑ sis of this, the patient was diagnosed as have TTS associated with dengue fever. The patient was medically treated with success and was later discharged. He remains currently asymptomatic and his left ventricular ejection fraction recovered to normal (60%) on repeat echo after 6 months.