The recent report on acute shock dengue myocarditis is of great interest. Guadalajara-Boo et al1 report this finding in a case of dengue. In fact, fatal dengue myocarditis due to a dengue virus-induced cardiac lesion was reported a few years ago.2 An interesting question concerns the increased severity of the disease. According to the previous report from a highly endemic area, Thailand, dengue myocarditis is rare but is not fatal.3 This observation has many possible explanations. Basic fluid management is the key therapeutic strategy for any dengue case and proper management avoids severe complications.4 However, because cardiac complications of dengue seem to be a rare presentation, diagnosis can be delayed, resulting in high fatality.5 This problem can be seen in nonendemic areas with a new emerging dengue problem where physicians lack experience in the management of dengue. In addition, a remaining question is whether there are any genetic mutations in the dengue virus that may have increased its cardiac pathogenicity. Further research on this topic is required.