Afebrile dengue myositis

How to cite this article:
Yasri S, Wiwanitkit V. Afebrile dengue myositis. Ann Trop Med Public Health 2016;9:360


How to cite this URL:
Yasri S, Wiwanitkit V. Afebrile dengue myositis. Ann Trop Med Public Health [serial online] 2016 [cited 2020 Aug 9];9:360. Available from:

Dear Sir,

Dengue is a common tropical infection that can be seen worldwide. Sometimes, atypical presentation can be seen. [1] Afebrile dengue is an actual challenge in clinical practice since it can be easily missed. [2] Here, the authors report a case of dengue patient who presents without fever but with severe myalgia. The patient is a 36-year-old female complaining of severe muscle pain for 2 days. Her vital sign is within normal limit. There is no fever. In this case, the complete blood count is done and thrombocytopenia can be seen. Further investigation shows positive dengue IgM, and high serum creatine phosphokinase can also be seen. In this patient, afebrile dengue myositis is diagnosed. Indeed, dengue myositis is a condition to be properly managed because it might result in renal failure. [3] For this condition, Siriyakorn and Insiripong noted that “it may theoretically be proposed such as direct muscle cell injury leading to myositis by dengue virus, myotoxic cytokines which are produced in response to viral infection, dehydration, or hypophosphatemia.” [4] In the present case, standard fluid replacement therapy for dengue is given to the patient and the patient has fully recovery within 3 days. In the present case, the missed diagnosis can be expected if there is no laboratory investigation and the increased creatine kinase level might be overlooked. The condition of afebrile dengue myositis should be listed in the differential diagnosis of any patient presenting with severe myalgia in the endemic area of dengue.

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Conflicts of interest

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Wiwanitkit V. Dengue fever: Diagnosis and treatment. Expert Rev Anti Infect Ther 2010;8:841-5.
Wiwanitkit S, Wiwanitkit V. Afebrile dengue: An easily forgotten manifestation. Ann Trop Med Public Health 2013;6:686.
Gupta M, Nayak R, Khwaja GA, Chowdhury D. Acute disseminated encephalomyelitis associated with dengue infection: A case report with literature review. J Neurol Sci 2013;335:216-8.
Siriyakorn N, Insiripong S. Fatal rhabdomyolysis in dengue hemorrhagic fever: A case report. Southeast Asian J Trop Med Public Health 2015;46 Suppl 1:149-52.

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.190204

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