title: Acute renal failure due to rhabdomyolysis following dengue viral infection: a case report.
abstract: BACKGROUND
  With more than one-third of the world's population living in areas at risk for transmission, dengue fever is a leading cause of illness and death in the tropics and subtropics. Despite the high incidence of dengue fever, rhabdomyolysis leading to acute renal failure is an extremely rare complication of dengue fever. Only a few such cases have been reported in the literature.
  
  
  METHODS
  We describe the case of a 42-year-old, previously healthy Sri Lankan Sinhalese man who developed acute renal failure due to rhabdomyolysis following dengue virus infection. He was transferred to our institution with a five-day history of fever, headache, myalgia, impaired level of consciousness, and reduced urinary output. He was hemodynamically stable and did not have evidence of plasma leakage. His serology for dengue immunoglobulin M and immunoglobulin G was positive, and biochemical investigations disclosed evidence of rhabdomyolysis and acute renal failure. He was treated with induced alkaline diuresis and hemodialysis, and he experienced an uncomplicated recovery.
  
  
  CONCLUSIONS
  The occurrence of acute renal failure significantly increases the mortality of patients with dengue fever. Therefore, early diagnosis and early management are crucial in rhabdomyolysis complicating dengue fever to prevent established acute renal failure. It should be kept in mind that the threshold for suspecting rhabdomyolysis is very low in dengue fever. Creatinine phosphokinase levels should routinely be measured in all patients with severe dengue fever for early detection of rhabdomyolysis to prevent acute renal failure.
authors.affiliation: Ward 45, National Hospital of Sri Lanka, Colombo, Sri Lanka. arunawijesinghe@gmail.com.
authors.forename: Aruna
authors.initials: A
authors.lastname: Wijesinghe
authors.forename: Nanthini
authors.initials: N
authors.lastname: Gnanapragash
authors.forename: Gayan
authors.initials: G
authors.lastname: Ranasinghe
authors.forename: Murugapillai K
authors.initials: MK
authors.lastname: Ragunathan
references.citation: J Pediatr. 2010 Aug;157(2):303-9
references.pmid: 20362302
references.citation: Singapore Med J. 2005 Nov;46(11):645-6
references.pmid: 16228098
references.citation: Pediatr Infect Dis J. 2010 Mar;29(3):238-42
references.pmid: 20032806
references.citation: N Engl J Med. 2009 Jul 2;361(1):62-72
references.pmid: 19571284
references.citation: Ann Indian Acad Neurol. 2010 Jul;13(3):221-2
references.pmid: 21085538
references.citation: Clin Infect Dis. 2004 May 15;38(10):e109-11
references.pmid: 15156504
references.citation: Ceylon Med J. 2000 Dec;45(4):181
references.pmid: 11293970
references.citation: N Engl J Med. 2012 Apr 12;366(15):1423-32
references.pmid: 22494122
references.citation: Am J Trop Med Hyg. 2009 Apr;80(4):651-5
references.pmid: 19346394
references.citation: J Gen Virol. 2008 Jul;89(Pt 7):1605-1615
references.pmid: 18559930
references.citation: Ann Clin Biochem. 2000 Sep;37 ( Pt 5):581-7
references.pmid: 11026512
references.citation: Clin Chem. 2009 Dec;55(12):2190-7
references.pmid: 19797717
references.citation: Case Rep Med. 2013;2013:101058
references.pmid: 23424589
references.citation: Arch Intern Med. 1988 Jul;148(7):1553-7
references.pmid: 3382301
references.citation: J Med Virol. 2002 May;67(1):41-6
references.pmid: 11920816
references.citation: Ren Fail. 2005;27(5):647
references.pmid: 16153008
references.citation: Intensive Care Med. 2003 Jul;29(7):1121-5
references.pmid: 12768237