Acute dengue myositis with rhabdomyolysis and acute renal failure

Abstract

Dengue is an acute mosquito-borne infection caused by dengue viruses from the genus flavivirus. Neurologic complications have been attributed chiefly to metabolic alterations and to focal and sometimes massive intracranial haemorrhages, but anecdotal cases and limited case series have indicated the possibility of viral CNS and skeletal muscle invasion causing encephalitis and myositis. We present a case of a 40-year-old male who presented with severe dengue myositis resulting in quadriparesis, respiratory failure and acute renal failure with red urine. His elevated serum creatine kinase (CK), serum and urine myoglobin levels justified rhabdomyolysis as the cause of acute renal failure. A muscle biopsy revealed inflammatory myositis. He required ventilator support for respiratory failure and was treated conservatively. This case highlights the severe and persistent muscle involvement in dengue which is a rarity.

Neurological manifestations of dengue viral infection

“…Clinical case series of dengue patients reported elevated creatinine phosphokinase (CPK) levels in most of them, myalgia in 63%, and mild muscle weakness in around 3%. [64][65][66][67][68][69][70] The term "dengue associated transient muscle dysfunction" is now preferred to dengue myositis due to the benign self-limiting nature.…”

Clinical Features of and Risk Factors for Rhabdomyolysis Among Adult Patients with Dengue Virus Infection

“…5,6 As the number of dengue cases is increasing globally, 1 the incidence of rhabdomyolysis associated with DENV infection is also increasing. [7][8][9][10][11][12][13][14][15][16][17][18] Rhabdomyolysis is a potentially life-threatening syndrome characterized by the breakdown of skeletal muscle. 19 Inappropriate treatment of this condition can lead to electrolyte disturbances, metabolic acidosis, coagulation defects, and acute kidney injury.…”

“…[19][20][21][22][23][24] However, only a few studies on rhabdomyolysis associated with DENV infection are available, and all of them are case reports or literature reviews. [7][8][9][10][11][12][13][14][15][16][17][18] The uncommon and atypical manifestation of dengue-related rhabdomyolysis has limited clinician awareness. Delayed or missed diagnosis and inappropriate treatment of dengue-related rhabdomyolysis could result in serious complications, such as acute kidney injury and even death.…”

“…Delayed or missed diagnosis and inappropriate treatment of dengue-related rhabdomyolysis could result in serious complications, such as acute kidney injury and even death. [7][8][9][10][11][12][13][14][15][16][17][18] To elucidate the clinical features of and risk factors for denguerelated rhabdomyolysis, we conducted a retrospective analysis of patients with dengue that was diagnosed over an 11-year period in a large medical center. We aimed to better understand the demographic, clinical, and laboratory characteristics of rhabdomyolysis in adult dengue patients and identify the risk factor(s) for developing rhabdomyolysis as well as cytokine/ chemokine responses in dengue patients with rhabdomyolysis.…”

Proteinuria asociada al dengue

“…La gravedad de estos órganos dañados además del riñón (hígado, miocardio, músculo esquelético, sistema nervioso central y periférico) es muy variable y no existen factores predictores conocidos de [14][15][16][17][18][19][20] severidad. Se cree que infecciones previas con otros serotipos del virus predisponen a una gran liberación de citoquinas que persisten en la memoria inmunológica.…”