Rhabdomyolysis Associated with Dengue Virus Infection

Abstract

We describe 2 patients who developed rhabdomyolysis due to dengue virus infection. The first patient recovered with no sequelae, but the second developed multiple organ failure and died. Rhabdomyolysis is not well described as a complication of dengue virus infection and is probably underrecognized. All patients with severe dengue virus infection should undergo urinalysis, and serum creatinine kinase levels should be measured if urinalysis reveals heme.

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

“…Direct invasion by DENV or production of myotoxic cytokines, particularly TNFs, has been postulated. 8,17 In this study, IL-6 and TNF-α levels were significantly elevated in patients with rhabdomyolysis compared with those without rhabdomyolysis. TNF-α is a proinflammatory cytokine involved in systemic inflammation, and it is associated with increased disease severity.…”

“…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.…”

Acute Tubular Necrosis Associated with Non-Hemorrhagic Dengue Fever: A Case Report

“…These included acute tubular necrosis, which may be associated with interstitial edema and mononuclear infiltration; acute glomerulonephritis; thrombotic microangiopathy; and myoglobinuric renal failure within the context of multiorgan failure. [4,10,[19][20][21][22] It is noteworthy that DF may have a benign form in renal transplant recipients. [23,24] Histopathological diagnosis of the acute renal failure is scarce, and it seems that most of the ATN diagnosis is formulated on clinical grounds.…”