Musculoskeletal Manifestations of Dengue Fever

Abstract

Introduction: Dengue fever is a multisystem disease that can present with varying severity. With the increasing incidence of dengue-associated morbidity and mortality globally, atypical manifestations are now included in the case definition of severe dengue. Musculoskeletal involvement in dengue ranges from troubling myalgia to life-threatening rhabdomyolysis. However, it is often underreported and underdiagnosed due to a lack of awareness. Hence, this study was undertaken to evaluate dengue patients for specific musculoskeletal presentation. Materials and Methods: A prospective study was undertaken between September 2020 and August 2022, with 200 adult dengue patients presenting to the outpatient department or hospitalized in patient department (IPD) at a rural tertiary care hospital. They were assessed, the diagnosis was confirmed with serology, and they were subjected to thorough clinical examination and relevant laboratory studies as was necessary to establish musculoskeletal features of dengue. Results: Ninety-five percent of patients had myalgia, 13.5% of patients had myositis, and 14% of patients were found to have hypokalemia; however, only 2.5% of patients developed hypokalemic periodic paralysis. Seventy-three percent of cases reported arthralgia, while none of the cases reported arthritis or rhabdomyolysis. Conclusion: Musculoskeletal manifestations of dengue are common, although they are underreported in medical literature. However, many patients with dengue illness presenting with myalgia and progressing to myositis may not have been noticed in practice due to a lack of awareness. Hence, developing awareness and early recognition of this treatable manifestation of dengue become necessary.

Keywords

• hypokalemic periodic paralysis
• musculoskeletal manifestations of dengue
• myositis
• severe dengue