Myocardial ischemia and myocardial infarction is rare in children, with Kawasaki disease in children and substance abuse in adolescents, being the main cause. We present a case of a 12-year child suffering from Dengue, with bicuspid aortic valve, complicated by aortic valve insufficiency, who presented with chest pain and ECG changes of myocarditis and acute coronary syndrome; a rare occurrence. He was referred to us with complains of fever, cough, black colored stool, burning abdominal pain, and vomiting after 4 days of hospitalization at a district hospital as dengue illness. On day 9 of illness, he developed large hematemesis, with severe precordial chest pain, and was diagnosed initially as a case of acute myocardial ischemia due to myocarditis following dengue fever. ECG showed ST depression and troponin-I was markedly raised. Oxygen, ventilator, inotropes, streptokinase in divided doses (after bleeding had stopped), and steroids, zinc and vitamins C, E were administered. ECG changes reversed in a few hours and q waves started to appear. Later, 2D ECHO showed bicuspid aortic valve with aortic valve insufficiency. Myocardial enzymes, troponin-I and ECG returned to normal after 14 days. He was discharged on cardio supportive medications and advised valve replacement. Bicuspid aortic valve may remain undiagnosed till adolescence and can present rarely as acute myocardial ischemia following Dengue that was treated with streptokinase.

Keywords: Bicuspid aortic valve; Adolescent; Electrocardiogram; Acute myocardial infarction; Streptokinase; Dengue.