Dengue Fever Presenting with Severe Myositis-A Case Report
Life Sciences -General Medicine
DOI:
https://doi.org/10.22376/ijlpr.2023.13.2.L56-L61Keywords:
Dengue, Neuromuscular complications of Dengue, Myalgia, Myositis, Elevation of Creatine phosphokinase(CPK)Abstract
Dengue fever is one of the most common vector-borne diseases, which is a viral infection transmitted by female Aedes aegypti mosquitoes. It is most common in tropical countries like India. Dengue fever symptoms can range from a mild infection to severe flu-like sickness. Myalgia is a symptom of dengue infection. Dengue fever with myositis and/or high serum creatine phosphokinase (CPK) levels, on the other hand, is extremely uncommon. Dengue virus can cause myositis in many mechanisms. One of the most common mechanisms is by direct invasion of the myocytes by the dengue viruses. Myotoxins, Inflammatory cytokines have also been a part of the development of myositis. The clinical spectrum is broad, from the mild asymmetrical weakness of lower extremities to sudden progressive severe limb and trunk weakness, and even lung failure. This case study aims to show the rare neuromuscular complications of dengue fever, which can be managed well with a high index of suspicion. Our patient presented with fever and severe myalgia and was diagnosed with dengue. We started treating the patient with a provisional diagnosis of dengue-associated myositis. Significantly elevated CPK levels confirmed the myositis. Hereby, we are presenting a case of dengue fever with myositis with muscle weakness & elevated creatine phosphokinase (CPK) levels who recovered completely with early suspicion of dengue-associated myositis and early management. Hence, Physicians should have a high index of suspicion and early management of dengue-associated neuromuscular complications.
References
Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG et al. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis. 2012;6(8):e1760. doi: 10.1371/journal.pntd.0001760, PMID 22880140.
Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL et al. The global distribution and burden of dengue. Nature. 2013 Apr;496(7446):504-7. doi: 10.1038/nature12060, PMID 23563266.
World Health Organization and tropical diseases research. Handbook for clinical management of dengue. Geneva: World Health Organization; 2012.
Filippone C, Legros V, Jeannin P, Choumet V, Butler-Browne G, Zoladek J et al. Arboviruses and muscle disorders: from disease to cell biology. Viruses. 2020 Jun;12(6):616. doi: 10.3390/v12060616, PMID 32516914.
Misra UK, Kalita J, Syam UK, Dhole TN. Neurological manifestations of dengue virus infection. J Neurol Sci. 2006 May 15;244(1-2):117-22. doi: 10.1016/j.jns.2006.01.011, PMID 16524594.
Verma R, Holla VV, Kumar V, Jain A, Husain N, Malhotra KP et al. A study of acute muscle dysfunction with particular reference to dengue myopathy. Ann Indian Acad Neurol. 2017 Jan;20(1):13-22. doi: 10.4103/0972-2327.199914, PMID 28298837.
Garg RK, Malhotra HS, Jain A, Malhotra KP. Dengue-associated neuromuscular complications. Neurol India. 2015 Jul 1;63(4):497-516. doi: 10.4103/0028-3886.161990, PMID 26238884.
Nath P, Agrawal DK, Mehrotra RM. Ultrastructural changes in skeletal muscles in dengue virus-infected mice. J Pathol. 1982;136(4):301-5. doi: 10.1002/path.1711360405, PMID 7077434.
Salgado DM, Eltit JM, Mansfield K, Panqueba C, Castro D, Vega MR, et al. Heart and skeletal muscle are targets of dengue virus infection. Pediatr Infect Dis J. 2010;29(3):238-42. doi: 10.1097/INF.0b013e3181bc3c5b, PMID 20032806.
Warke RV, Becerra A, Zawadzka A, Schmidt DJ, Martin KJ, Giaya K, et al.
Warke RV, Becerra A, Zawadzka A, Schmidt DJ, Martin KJ, Giaya K et al. Efficient dengue virus (DENV) infection of human muscle satellite cells upregulates type I interferon response genes and differentially modulates MHC I expression on bystander and DENV-infected cells. J Gen Virol. 2008;89(7):1605-15. doi: 10.1099/vir.0.2008/000968-0, PMID 18559930.
Beauvais P, Quinet B, Richardet JM. Dengue. Apropos of 2 cases. Arch Fr Pediatr. 1993;50(10):905-7. PMID 8053773.
Das S, Sarkar N, Chatterjee K, Aich B. Flaccid quadriparesis due to severe myositis and Bell’s palsy in pediatric dengue infection. J Pediatr Infect Dis. 2014;9:27-30.
Misra UK, Kalita J, Syam UK, Dhole TN. Neurological manifestations of dengue virus infection. J Neurol Sci. 2006;244(1-2):117-22. doi: 10.1016/j.jns.2006.01.011, PMID 16524594.
Acharya S, Shukla S, Mahajan SN, Diwan SK. Acute dengue myositis with rhabdomyolysis and acute renal failure. Ann Indian Acad Neurol. 2010;13(3):221-2. doi: 10.4103/0972-2327.70882, PMID 21085538.
Ahmad R, Abdul Latiff AK, Abdul Razak S. Myalgia cruris epidemica: an unusual presentation of dengue fever. Southeast Asian J Trop Med Public Health. 2007;38(6):1084-7. PMID 18613550.
Pimentel LH, de Oliveira GR, do Vale OC, Gondim Fde A. On the spectrum of acute dengue virus myositis. J Neurol Sci. 2011;307(1-2):178-9; author reply 180. doi: 10.1016/j.jns.2011.05.018, PMID 21624625.
Hira HS, Kaur A, Shukla A. Acute neuromuscular weakness associated with dengue infection. J Neurosci Rural Pract. 2012;3(1):36-9. doi: 10.4103/0976-3147.91928, PMID 22346188.
Sardana V, Gupta R. Benign acute myositis-an unusual presentation of dengue fever. Indian J Med Case Rep. 2012;1:38-9.
Aggarwal HK, Jain DD, Pawar S, Jain P, Mittal A. Dengue fever presenting as myositis: an uncommon presentation. Research. 2014;1:985.
Das S, Sarkar N, Chatterjee K, Aich B. Flaccid quadriparesis due to severe myositis and Bell’s palsy in pediatric dengue infection. J Pediatr Infect Dis. 2014;9:27-30.
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