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Case Report | DOI: https://doi.org/10.31579/2692-9759/174
*Corresponding Author: Richmond R Gomes, Associate Professor, Medicine Ad-din Women’s Medical College Hospital, Bangladesh.
Citation: Richmond R Gomes, (2025), Dengue Myocarditis leading to Acute Cardiac Failure: Rare Manifestation of Expanded Dengue Syndrome, Cardiology Research and Reports, 7(5); DOI:10.31579/2692-9759/174
Copyright: © 2025, Richmond R Gomes. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 04 August 2025 | Accepted: 13 August 2025 | Published: 25 August 2025
Keywords: acute heart failure; acute myocarditis; cardiomyopathy; expanded dengue syndrome; dengue fever
Dengue is a prevalent arthropod-borne viral disease in tropical and subtropical areas of the globe. Dengue clinical manifestations include asymptomatic infections; undifferentiated fever; dengue fever, which is characterized by fever, headache, retroorbital pain, myalgia, and arthralgia; and a severe form of the disease denominated dengue hemorrhagic fever/dengue shock syndrome, characterized by hemoconcentration, thrombocytopenia, and bleeding tendency. However, atypical manifestations, such as liver, central nervous system, and cardiac involvement, have been increasingly reported. called expanded dengue syndrome. We report a 40 years old gentleman with atypical and rare presentation of dengue disease marked by a dramatic and fatal acute cardiac failure due to acute myocarditis. Condition improved after five days of conservative treatment. Cardiac complications in dengue are now increasingly observed with the most common case ismyocarditis. The main mechanism of dengue myocarditis is still unknown though both directviral infection and immune mediated damage have been suggested to be the cause ofmyocardial damage. The low incidence of dengue myocarditis is because it’s asymptomaticand diagnosis is easily missed. Almost all cases of dengue myocarditis are self-limiting andsevere myocarditis leading to dilated cardiomyopathy is extremely rare. To avoid otherwise preventable morbidity and mortality, physicians should have a highindex of suspicion for cardiac complications in patients with dengue illness and should manage thisaccordingly.
Dengue, an arthropod-borne viral infection of humans, is endemic to tropical and subtropical regions of the world and represents an important public health problem. Dengue viruses are transmitted by the bite of the Aedesaegypti mosquito infected by the one of the four dengue virus serotypes: dengue-1, -2, -3, and -4. More recently, dengue disease has spread geographically to many previously unaffected areas and, as travelling around the world has become more accessible, physicians in temperate areas are more likely to see returning travelers with dengue infection.1,2
World Health Organization (WHO) classification of symptomatic dengue infection, continuously evolved, first in 1997 it divided into dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). In 2009 it improved into dengue with or without warning signs and severedengue.[3]
However, in 2011, WHO Regional Office for South East Asia (SEARO) revised and further improving the classification, divided into DF, DHF without shock or with shock (DSS) characterized by increased vascular permeability, thrombocytopenia (platelets <100,000), bleeding tendency, and, in a small percentage of patients, circulatory shock.[4,5,6,7]and expanded dengue syndrome.[8]
Expanded dengue syndrome is a new entity added to the classification system to incorporate a wide spectrum of unusual manifestations of dengue infection affecting various organ systems that had been reported including gastrointestinal, hepatic, neurological, cardiac, pulmonary and renal systems.8Of note, a variety of cardiac complications have been reported indengue-affected patients, which include atrioventricular conductiondisorders,9supraventricular arrhythmia,10and myocarditis11,12. The most commoncomplication is myocarditis. However, the study of myocarditis in dengue is still very lacking. The pathogenesis of myocarditis in dengue is still not clear. Clinical manifestation of myocarditis dengueis varied. Endomyocardial biopsy (EMB) is a deterministic diagnostic method but difficult topopularize. According to the ESC (European Society of Cardiologist) New Criteria, the combination of symptoms, electrocardiography, cardiac enzyme marker and cardiac imaging can use to diagnosethe dengue hemorrhagic fever patient with myocarditis. The fatal complications of dengue myocarditis are arrhythmias, heart failure, cardiogenic shock until death.[13]
Although reports of a more severe disease with progression to cardiogenic shock and death have been increasingly described,[14,15,16] the pathogenesis of myocardial lesions has not been elucidated. We present a rare case of a fulminant and fatal myocarditis leading to acute heart failure caused by dengue.
A 40-year-old gentleman was admitted to Ad-din Women’s Medical College Hospital, Dhaka, Bangladesh with a history of progressive dyspnoea in the last 3 days that had recently evolved to dyspnoea at rest and orthopnoea, atypical chest pain and palpitation. Eight days prior the admission, he complained of fever, headache, retro-orbital pain, generalized bodyache and weakness for 6 days followed by afebrile for last 2 days. There are spontaneous bleeding complaints in the form of nosebleeds 1-day prior admission to hospital His past medical history was positive only for a diagnosis of primary hypothyroidism for last four years for which he was taking tablet thyroxin 50 mcg daily regularly. From the previous history of disease did not get the history of dengue fever, diabetes mellitus, bronchial asthma, hypertension and heart disease. Patients do not smoke and do not consume alcohol.
On clinical examination, he was in severe condition, agitated, dyspnoeic with signs of poor peripheral perfusion, such as cold extremities and cyanosis. Heart rate was 105 bpm, blood pressures 60/30 mm of Hg, respiratory rate 28 breaths/min, axillary temperature 98.2ºF. SaO2 was 85% in room air. Bi pedal edema was present. Haemorrhagic suffusions or other skin lesions were absent except right subconjuctival hemorrhage and positive rumple leed test. On examination of the head and neck, there is no anemia or jaundice. No enlargement of lymph nodes nor increased jugular venous pressure. On precordial examination there was gallop with no murmur. On abdominal examination, there was no ascites with normal bowel sounds, liver and spleen were not palpable. On chest examination, Bi basal mid to late inspiratory coarse rales were present over both lung base with no rhonchi. Breath sound was vesicular.
On laboratory investigations, hemoglobin 11.1 g/dL, leukocyte 5600/μL with normal differentials, platelet 45,000/μL, HCT 33.8%, SGPT 66U/L( normal less than 40U/L), Alb 4.8g/dL, serum creatinine 0.75mg/L, sodium 132mmol/L, potassium 3.6mmol/L, chloride 101mmol/L,HCO3 20 mmol/L. HbsAg (non-reactive), CKMB 77U/L (normal 7.0-25.0U/L) and troponin I 2.71ng/mL (normal <0.02 ng/mL). IgM Anti dengue antibody came positive. Chest x ray revealed bilateral opacities extending from both hilum with bat wing appearance suggestive of pulmonary edema(Figure 1). USG of whole abdomen revealed thickened GB wall with mild ascites. Urine routine examination was normal. NT-Pro BNP was 27332 pg/ml(normal less than 400 pg/ml). The 12-lead electrocardiogram detected diffuse ST-segment elevation(figure 2). Emergency transthoracic echocardiography was performed at bedside and showed mild pericardial effusion, without signs of cardiac tamponade, dilated left ventricle with diffuse hypokinesia of left ventricular wall. There was severe left ventricular dysfunction with ejection fraction was 36%. Interventricular septum was normal. So diagnosis of dengue hemorrhagic fever with dengue myocarditis with acute pulmonary edema was made as a part of expanded dengue syndrome.
Resuscitation with intravenous frusemide, sodium bicarbonate, vasoactive drugs and digoxin were promptly initiated. Dopamine was used in progressive doses up to 20 µg/kg/min along with frusemide infusion 15 mg/hour along with high flow, high concentration oxygen. He continued receiving intravenous frusemide and dopamine for a further 2 days. With treatment his condition improved with decreasing shortness of breath. On 4th day dopamine infusion was stopped and frusemide infusion was substituted by bolus injection.
Figure 1and 2: showing chest x-ray suggestive of pulmonary edema and ECG with diffuse ST elevation respectively.
On 7th day of admission, his condition further improved with no shortness of breath even on exertion. Repeat CKMB 17U/L (normal 7.0-25.0U/L), troponin I 0.7ng/mL (normal <0.02 ng/mL), NT-Pro BNP was 996 pg/ml(normal less than 400 pg/ml). He was discharged on 9th day of admission with stable hemodynamic condition with no clinical signs of heart failure. He was advised to follow up on outpatient door after 2 weeks.
Discussion: Dengue is a worldwide public health problem and causes innumerous deaths. More than 40% of the world’s population lives in dengue endemic areas, and the World Health Organization estimates that about 2.5 billion people in 100 countries are at risk of infection and that as many as 100 million people are infected by dengue viruses every year. In the majority of infected people, dengue is an auto-limited disease that resolves in 5–7 days. However, approximately 500,000 people develop a severe form, leading to about 20,000 deaths annually. Consequently, approximately 0.5% of dengue patients develops a severe form and requires a specialized treatment. [2,17]
Dengue virus infection is a disease that found in children and adults with the main symptoms of fever, muscle and joint pain that usually worsens after the first three days. This disease is an acute febrile illness accompanied by bleeding manifestations with potential shocking and can lead to death in children<15 years, but not likely to attack adults.[18] Signs of this disease are sudden high fever 2 to 7 days with no obvious cause, weakness, lethargy, anxiety, heartburn, accompanied by signs of bleeding in the skin (petechiae), bruising (ecchymosis) or rash (purpura). Sometimes there are other spontaneous bleeding manifestations such as nosebleeds, bleeding gums to dysentery. Severe symptoms can lead to decreased awareness or shock.[19]
Laboratory results in dengue fever are found in thrombocytopenia (20% of the baseline on dengue hemorrhagic fever is a sign of plasma. Serological tests results in dengue are influenced by the type of dengue infection, whether it is the primary/first, or secondary/reinfection. IgM antibodies are detectable by days 3–5 after the onset of illness, rise quickly in two weeks and decline to undetectable levels after 2–3 months, because this late appearance, the first five days of clinical illness are usually negative of IgM. In dengue secondary infection, the rise of IgM are not as high as primary infection, and sometimes absent / undetectable completely.[20]
IgG antibodies in primary infection, evolves relatively slow, with low titres 8-10 days after fever onset, increase subsequently and remain for many years, whereas in secondary infection it evolves rapidly, with high titres soon after fever onset and persist to a lifelong period. Hence, a ratio of IgM/IgG is commonly used to differentiate between primary and secondary dengue infections. Ratio of IgM/IgG titre less than 1.2 is considered a secondary dengue infection. But to be noted, titre ratio only could be validly use as a data if the IgG/IgM serological test is using pure quantitative means, not by qualitative or semi-quantitative.[21]
NS1 antigen detection is widely used and cost-effective, NS1 could be detected from day 1-8 of fever onset, unaffected by a primary or secondary dengue infection. In conclusion, by combining the serological (IgG and IgM) and NS1 tests, clinicians could rapidly assess the dengue diagnosis with its types (primary or secondary infection) and applies the best treatment.[22]
In 2011, based on many reports of cases with dengue-related unusual manifestations and organ complications, WHO-SEARO further improved and revised 2009 WHO guidelines by adding a new entity, that is expanded dengue syndrome (unusual/atypical manifestation of dengue), these include neurological, hepatic, renal, cardiac and other isolated organ involvement, that could be explained as complications of severe, profound shock or associated with underlying host conditions/diseases or coinfections. [8]
The incidence of cardiac complications in patients with dengue illness varies greatly from one series to another. From India, Agarwal et al. reported that only one of 206 patients subjected to cardiovascular evaluation experienced cardiac symptoms;23Wali et al., reported that 70% of 17 patients with DHF/DSS who underwent myocardial scintigraphic study suffered diffuse left ventricular hypokinesis with a mean ejection fraction of 40%;24 and Kabra et al., reported that 16.7% of 54 children with dengue illness had a decreased left ventricular ejection fraction of<50A>
The clinical manifestations of cardiac complications in dengue illness vary considerably.[9-12,14,24,25] At one end of the clinical spectrum, patients are asymptomatic or have mild cardiac symptoms despite relative bradycardia, transient atrioventricular block, and/or ventricular arrhythmia.[9,10,24,27,28.] At the other severe end, patients may experience acute pulmonary edema and/or cardiogenic shock due to severe myocardial cell damage with left ventricular failure.[6,9,11,12,14,24,29] Myocarditis can masquerade as acute myocardial infarction.29,30.Clinical presentation in myocarditis is varied. The sign and symptoms are chest pain, dyspnea at rest or exercise, palpitation, syncope, cardiac shock and sudden cardiac death.13Cardiac arrhythmias are other clinical manifestations of myocarditis. Various arrhythmias have been described during dengue virus infection such as atrial fibrillation, ventricular tachycardia and even atrioventricular blocks. These arrhythmias are associated to syncope and even sudden death[10,27.]
According to the diagnostic criteria from European Society of Cardiology 2013, dengue patients were subjected to electrocardiogram (ECG), echocardiography and cardiac enzyme test (CET) to make the diagnosis of myocarditis. Myocarditis was diagnosed if 1 or more clinical presentation and 1 or more auxiliary diagnosis method; 2 or more auxiliary diagnosis method should be met if the patient is asymptomatic. 12 leads ECG was considered abnormal with any of following, such as sinus arrest, AV-block, bundle branch block, atrial fibrillation, ST wave change (ST elevation, ST depression, T inversion), abnormal Q waves. Based on echocardiography usually found functional and structural abnormalities such as ventricular dilatation, increased wall thickness, diastolic function abnormality, pericardial effusion, left ventricular ejection fraction less than 55%, valvular regurgitation or vegetation. The cardiac enzyme was considered to be elevated and abnormal if CK-MB more than 25U/L and/or cTnI more than 0.02ng/m and/or NT-proBNP more than 450ng/L (age 75 years). The gold standard to diagnose myocarditis is EMB (Endomyocardial Biopsy), but it is not performed regularly.13 As for the cardiac complication in this reported patient, the differential diagnosis included acute myocardial infarction and acute myocarditis; the former is characterized by a blockage of the coronary arteries, while the latter has patent coronary arteries. However, rapid clinical improvement after the development of hypotension and acute pulmonary edema unequivocally indicated that this was a case of myocarditis.
The pathogenesis myocarditis in dengue patient is still unclear. The mechanism of myocardial damage in dengue could be the release of inflammatory mediators and the direct action of the virus on cardiomyocytes, as seen in acute myocarditis caused by other viruses31. Using immunofluorescence confocal microscopy in heart tissue, Salgado et al 32reported that myotubes were infected by dengue virus in one child with fatal DHF, although the myocardium sections appeared morphologically normal, with minimal cellular, infiltrates.
Figure 2: Pathogenesis myocarditis in dengue infection virus 34
The gold standard of myocarditis in dengue patient is Endomyocardial Biopsy, the fulminant course of clinical dengue myocarditis was associated with intense interstitial edema, several multifocal areas of necrosis, and diffuse inflammatory infiltration. Interestingly, the myocytolitic necrotic areas were replete with virus particles; therefore providing detailed histological evidence of a possible dengue direct action in cardiomyocytes. Further clinical and experimental studies are necessary to better understand the molecular mechanism of dengue virus-induced lesions on the myocardium33.
With respect to volume replacement for DHF patients with a 20% increase in hematocrit, the World Health Organizationrecommends intravenous infusion with 5% glucose in physiological saline at 6 ml/h/kg for the initial 1–2 h, followed by 3–5 ml/h/kg, which may be discontinued at 24 to 48 h depending on the normalization of hematocrit, pulse rate, and blood pressure. Overhydration may lead to fluid overload, resulting in respiratory distress in patients with dengue. In the present case, despite improvement in the serial hematocrit after fluid therapy, hypotension developed on the third day of treatment suggesting that this resulted from cardiac dysfunction rather than insufficient intravenous fluid replacement, thus indicating that the patient’s pulmonary edema was cardiogenic due to impairment of left ventricular function.[35]
Myocardial dysfunction has been reported to be more severe inpatients with DSS when compared to those with DF or non-shock DHF.36The pathophysiology of myocardial cell injury in dengue illness is not yet fully understood. Myocardial involvement in dengue may result either from direct DEN invasion of the cardiac muscles or a cytokine-mediated immunological response, or both.37,38The upsurge in serum tumor necrosis factor-a, interleukins 6, 13 and 18, and cytotoxic factors in patients with dengue illness lead to increased vascular permeability and shock;39,40whether these cytokines play a role in the development ofmyocardial cell injury is unknown. Of note, only DEN-2 and DEN-3 were reported to be the culprit viruses in dengue patients with cardiac complications where the DEN serotype was mentioned.9,14,24,25Further studies are needed to clarify the role that DEN serotypeplays, if any, in cardiac complications in dengue-affected patients.
Our review shows that cardiac complications are not uncommonin dengue illness. Although it was self-limiting in our patient under supportive treatment, acute myocarditis in dengue may be clinically severe to such an extent that it has a fatal outcome.6,29 Early recognition of myocardial involvement in dengue illness, prompt restoration of hemodynamic instability while avoiding fluid overload, and sparing unnecessary invasive management are important in treating dengue-affected patients with severe myocarditis.
Dengue virus can produce atypical manifestations as acute myocarditis leading to cardiogenic shock and death by a possible direct virus action on cardiomyocytes. Physicians taking care of dengue patients should be aware of this possible complication. Early recognition of myocardial involvement in dengue illness, prompt restoration of hemodynamic instability while avoiding fluid overload, and sparing unnecessary invasive management are important in treating dengue-affected patients with severe myocarditis.
None declared
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My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
Dear Grace Pierce, Editorial Coordinator of the journal IJCCR, I had a very positive experience with Auctores - Journal throughout the publication process. The Editorial Team was highly responsive, professional, and supportive at every stage. I would like to extend my sincere thanks to the Editor: Grace Pierce, for her guidance and assistance. The peer-review process was smooth and constructive, helping improve the quality of my work. I would gladly recommend Auctores Journal to fellow researchers and authors. Dr. SABITA SINHA, Medical Oncologist, MD (Electro Homeopathy).
