Myocardial Infarction in Polycythemia Vera and Dengue: A Case of Competing Risks

Abstract

A 71-year-old male with polycythemia vera, myocardial infarction, and acute dengue infection presentedwith intermittent chest pain, nausea, and fever. His medical history included hypertension, dyslipidemia,chronic kidney disease, and a prior myocardial infarction of unknown localization. Electrocardiographyrevealed ischemic changes and troponin T was significantly elevated (965 pg/mL). Given the regional dengueepidemic, NS1 antigen testing was performed and was strongly positive (64.93 S/Co; positive ≥1.0),confirming dengue. Laboratory findings included erythrocytosis (hematocrit 70.3%), mild thrombocytopenia(100,000/mm³), and worsening renal function (creatinine 1.6 mg/dL). The patient was diagnosed with a latepresentingmyocardial infarction in the context of polycythemia vera-induced hypercoagulability anddengue-associated thrombocytopenia, raising critical management challenges regarding percutaneouscoronary intervention (PCI) and antithrombotic therapy. Due to spontaneous symptom resolution and highbleeding risk, an immediate invasive strategy was deferred in favor of guideline-directed medical therapyand close monitoring. Platelets declined to 24,000/mm³, requiring conservative management ofthrombocytopenia, phlebotomy, and fluid replacement. A delayed coronary angiography revealed anoccluded proximal right coronary artery, but PCI was not performed due to lack of persistent symptoms.This case underscores the complex interplay between thrombosis and bleeding risks in high-riskcardiovascular patients, requiring a multidisciplinary approach to optimize outcomes.