Acute dengue virus myositis: a report of seven patients of varying clinical severity including two cases with severe fulminant myositis

Abstract

Background: Acute dengue myositis is characterized by fever and myalgia (with or without muscle weakness).

Method: The 7 cases of acute dengue myositis were retrospectively evaluated in the present study. Dengue myositis was diagnosed on the basis of a clinical picture consistent with the infection, elevated creatine phosphokinase, normal CSF, positive serum IgM for dengue virus, and the exclusion of other causes.

Results: The mean age of patients was 19.4 (range 3-40) years. Majority (5) of the patients were male. In our series 3 of the cases suffered from fulminant myositis. They were characterized by generalized weaknesses which included the respiratory muscles. All the 3 patients had markedly elevated creatine phosphokinase levels (ranging from 16,590 to 117,200 IU/L). Two patients suffering from fulminant myositis required mechanical ventilation. However, they succumbed to their illnesses. The third patient showed signs of improvement. One case had paraparesis and an elevated creatine phosphokinase level. However, a spontaneous complete recovery was observed. The remaining 3 cases had quadriparesis with trunk and neck weaknesses, sparing of respiratory muscles, creatine phosphokinase levels up to 3000 U/L. However, a complete recovery was observed in these patients within 4 weeks.

Conclusion: To conclude, early respiratory involvement, high creatine phosphokinase values, and severe myalgia suggest a severe form of dengue myositis.