Related Experiment Videos
Dengue. Muscle biopsy findings in 15 patients
S M Malheiros1, A S Oliveira, B Schmidt
1Department of Neurology, Escola Paulista de Medicina, São Paulo, Brasil.
Abstract:
Dengue is known to produce a syndrome involving muscles, tendons and joints. The hallmark of this syndrome is severe myalgia but includes fever, cutaneous rash, and headache. The neuromuscular aspects of this infection are outlined only in isolated reports, and the muscle histopathological features during myalgia have not been described. In order to ascertain the actual neuromuscular involvement in dengue and better comprehend the histological nature of myalgia, we performed a clinical and neurological evaluation, a serum CPK level and a muscle biopsy (with histochemistry) in 15 patients (4 males), median age 23 years (range 14-47) with classic dengue fever, serologically confirmed, during the brazilian dengue epidemics from September 1986 to March 1987. All patients had a history of fever, headache and severe myalgia. Upon examination 4 had a cutaneous rash, 3 had fever, and 3 a small hepatomegaly. The neurological examination was unremarkable in all and included a manual muscle test. CPK was mildly elevated in only 3 patients. Muscle biopsy revealed a light to moderate perivascular mononuclear infiltrate in 12 patients and lipid accumulation in 11. Mild mitochondrial proliferation was seen in 3, few central nuclei in 3, rare foci of myonecrosis in 3, and 2 patients had type grouping. Dengue in our patients, produced myalgia but no detectable muscle weakness or other neuromuscular involvement. The main histopathological correlation with myalgia seems to be a perivascular mononuclear infiltrate and lipid accumulation.
Insights
Dengue fever causes severe muscle pain (myalgia) but does not lead to detectable muscle weakness. Muscle biopsies show perivascular infiltrates and lipid accumulation as key findings in dengue-associated myalgia.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- Dengue fever is known to cause a syndrome affecting muscles, tendons, and joints, characterized by severe myalgia.
- Neuromuscular aspects and muscle histopathology during dengue-associated myalgia are poorly understood.
Purpose of the Study:
- To investigate the neuromuscular involvement in dengue fever.
- To describe the muscle histopathological features associated with dengue myalgia.
Main Methods:
- Clinical and neurological evaluations were performed on 15 dengue fever patients.
- Serum creatine phosphokinase (CPK) levels and muscle biopsies with histochemistry were analyzed.
- Patients were serologically confirmed for dengue during Brazilian epidemics (1986-1987).
Main Results:
- All patients experienced fever, headache, and severe myalgia; some had rash, fever, or hepatomegaly.
- Neurological examinations were unremarkable, and CPK levels were only mildly elevated in 3 patients.
- Muscle biopsies showed perivascular mononuclear infiltrate (12/15) and lipid accumulation (11/15) as primary findings.
Conclusions:
- Dengue fever in these patients caused myalgia without detectable muscle weakness or other neuromuscular involvement.
- Perivascular mononuclear infiltrate and lipid accumulation appear to be the main histopathological correlates of myalgia in dengue.