Rhabdomyolysis and Dengue Fever: A Case Report and Literature Review

Table 1

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

Authors and publication year	Country,; age, sex	Clinical findings	CPK level; (Admission/peak); (U/L)	Results of tests for dengue	Renal 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	>5000	Dengue 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 𝜇mol/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	51,555	Dengue 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 failure	17,548	Blood RT-PCR was positive for D2	Developed acute renal failure—actual creatinine values were not reported	Developed 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 urine	58,961	Dengue 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 myoglobinuria	156,900	Dengue IgM and IgG positive on day 9	Developed acute renal failure—serum creatinine 138 𝜇mol/L on day 1 and 315 𝜇mol/L on day 5	Developed 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	29,000	Dengue IgM ELISA was strongly positive	Developed acute renal failure—serum creatinine 2.6 mg/dL	Developed 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 testing	325,600	Dengue 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 𝜇mol/L on admission and 82 𝜇mol/L at discharge	Full recovery with supportive care

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