Table 1: Summary of clinical findings from case reports of dengue fever and rhabdomyolysis.

Authors and publication yearCountry,
age, sex
Clinical findingsCPK level
(Admission/peak)
(U/L)
Results of tests for dengueRenal function/acute renal failure Outcome

Gunasekera et al.
2000 [6]
Sri Lanka
28 years,
Female
Fever, myalgia, proximal muscle weakness, dark urine, dyspnea
Acute renal failure, hypotension
>5000Dengue IgM and IgG were positive by immunochromatography test
Dengue antibody titre for D2 was 2560 (normal <20)
Developed acute renal failure—serum creatinine peaked at 780  mol/L
Abdominal ultrasound showed normal kidneys
Complete and uneventful recovery after supportive treatment including mannitol and bicarbonate

Davis and Bourke 
2004 [4]
Darwin, Australia
33 years,
Male
Fever, retro-orbital pain,
malaise, macular rash, dark red-brown urine
51,555Dengue virus IgM negative on day 1 but positive on day 10
RT-PCR for serum dengue virus RNA on day 1 of hospitalization was positive for D2
Did not develop renal failure—serum creatinine levels were normal (actual values were not reported)Uncomplicated course with full recovery

Davis and Bourke 
2004 [4]
Darwin, Australia
33 years,
Male
Admitted to hospital with suspected dengue haemorrhagic fever and acute renal failure17,548Blood RT-PCR was positive for D2Developed acute renal failure—actual creatinine values were not reportedDeveloped multiple organ dysfunction
Died on day 2 of hospitalization

Lim and Goh 
2005 [8]
Singapore
27 years,
Male
Four-day history of fever, nausea, and myalgia; discharged and readmitted after presenting with persistent myalgia and dark red urine58,961Dengue virus IgM and IgG titres were negative on day 1 of hospitalization
Dengue IgM became positive on day 5
Did not develop acute renal failure—serum creatinine levels reported as normal (actual values were not given) Uneventful hospital stay with discharge on day 7 of second admission after treatment with intravenous hydration

Karakus et al.
2007 [7]
The Netherlands
66 years,
Male
Fatigue, muscle, bone, and joint pain, tea coloured urine; confirmed myoglobinuria156,900Dengue IgM and IgG positive on day 9Developed acute renal failure—serum creatinine 138  mol/L on day 1 and 315  mol/L on day 5Developed respiratory failure, septic shock and multiorgan failure; admitted to intensive care unit; Died on day 47

Acharya et al.
2010 [5]
India
44 years,
Male
Four-day history of fever and myalgia
On examination, he was febrile and had conjunctival congestion and diffuse muscle tenderness
Urine positive for myoglobin
29,000Dengue IgM ELISA was strongly positive Developed acute renal failure—serum creatinine 2.6 mg/dLDeveloped quadriparesis and respiratory failure
Required ventilator support for respiratory failure

Present case 
(Sargeant et al. 2012)
Jamaica
25 years old,
Male
Four-day history of fever, myalgia and generalized weakness. Started to pass red urine on day 8; myoglobinuria confirmed on urine testing325,600Dengue IgM negative on day 4 but positive on day 8
Dengue antigen (NS1) positive on day 4
Did not develop renal failure—serum creatinine was 63  mol/L on admission and 82  mol/L at dischargeFull recovery with supportive care

CPK: creatine phosphokinase; IgM: immunoglobulin M; IgG: immunoglobulin G, D2: dengue virus type 2, NS1: nonstructural protein 1.