Dr Loke Ealing graduated from the University of Ireland, Galway and subsequently returned to Singapore to work. She has rotated through several internal medicine postings over the last few years and is currently working in the department of Internal Medicine, Woodlands Health Campus.
Dengue Presenting With Rhabdomyolysis
Dengue virus is an endemic disease that is transmitted via the genus flavivirus mosquito. It is commonly associated with several fatal complications; such as dengue haemorrhagic fever. Rhabdomolysis is a rare but potentially fatal complication of Dengue but it is seldom described.
We present a case of a 33 year old bangaldeshi, Mr H, whom presents with Dengue complicated by transaminitis and rhabdomyolysis. He first presented to the accident and emergency department on day 3 of fever and was subsequently diagnosed as NS 1 Antigen positive Dengue. Other associated symptoms that were present were cough, loss of appetite and myalgia. There was no abdominal pain or haematuria of note. There was no evidence of any change in urine colour. Mr H was then sent back home. He then returned to the hospital and it was noted then that he presented with a creatine kinase level of 3281. His urine dipstick showed no red blood cells present in the blood.
On further history, the patient was noted to be a gardener. Mr H was not taking additional supplements, nor was there an increase in heavy exercising recently. He had full power over bilateral upper limbs and lower limbs. During this admission he was treated symptomatically and started on intravenous hydration. His creatinine kinase downtrended, his platelets improved, symptoms resolved and he was subsequently discharged well. There was no muscle tenderness upon discharge.
We feel that clinicians should be cautious of rhabdomyolysis presenting as a compilcation of dengue disease as prompt hydration could be started. Early recognition of rhabdomyolysis is crucial for preventing acute kidney injury. Patient should be educated on the warning signs and the necessary advise should be given to them to seek prompt medical attention.