title: 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).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  To conclude, early respiratory involvement, high creatine phosphokinase values, and severe myalgia suggest a severe form of dengue myositis.
authors.affiliation: Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Vimal Kumar
authors.initials: VK
authors.lastname: Paliwal
authors.forename: Ravindra Kumar
authors.initials: RK
authors.lastname: Garg
authors.forename: Ratish
authors.initials: R
authors.lastname: Juyal
authors.forename: Nuzhat
authors.initials: N
authors.lastname: Husain
authors.forename: Ritu
authors.initials: R
authors.lastname: Verma
authors.forename: Pawan Kumar
authors.initials: PK
authors.lastname: Sharma
authors.forename: Rajesh
authors.initials: R
authors.lastname: Verma
authors.forename: Maneesh Kumar
authors.initials: MK
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D003402:Creatine Kinase / Q000097:blood; D003715:Dengue / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D003716:Dengue Virus / Q000276:immunology*; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D009220:Myositis / Q000097:blood / Q000150:complications / Q000821:virology*
chemical_list: D007075:Immunoglobulin M; D003402:Creatine Kinase