An unusual case of dengue fever

In India spread of dengue fever and dengue haemorrhagic fever is increasing, neurological manifestations are also increasing, although they may be under reported because of lack of awareness. There are some atypical manifestations of dengue, such as dengue encephalitis, dengue rhabdomyolysis, dengue myocarditis, dengue hepatitis and dengue cholecystitis which are mostly go unnoticed. We report here a case of 20 year Fever, Headache and difficulty to movie the lower limbs female presented with of dengue fever with myocarditis and rhabdomyolysis. On CNS examination she had B/L lower limb power was 1+/5, proximal > distal. Her other systemic examination was normal. On MRI scan she had multiple small cerebellar bleed. On investigations, Dengue Ig G tests was Positive. CPK levels were high (1751), LDH leves were high (206) and urine myoglobin test was also positive suggestive of Rhabdomyolysis. In course of her illness she developed myocarditis too ECG showed tachycardia non specific ST-T changes and T wave inversion. Her 2D echo-cardiography report was normal. She was treated with good IV hydration, steroids, platelets transfusions n mannitol. At the time of discharge power in both limb was 4/5 and general condition improved.