1616 - Dengue fever with post-infectious weakness and inflammatory myopathy highlights the role of multidisciplinary medicine in addressing viral sequelae, guiding treatment, and optimizing functional recovery.

Case Diagnosis: Dengue fever with post-infectious weakness and inflammatory sequelae

Case Description: A 46-year-old right-handed woman from Grenada with a history of intermittent iron-deficiency anemia presented with progressive bilateral lower extremity weakness (proximal > distal), mild right upper extremity weakness, and diffuse muscle pain. These symptoms followed a confirmed dengue infection (IgM positive). She denied sensory loss, and reflexes were preserved. Outside providers initially suspected Guillain-Barré syndrome, but intact sensation and preserved reflexes argued against it. Brain and spine MRI revealed no demyelinating disease. On admission, she exhibited leukocytosis, thrombocytosis, elevated CRP, and anemia of chronic disease, though creatine kinase was normal. Her pain and weakness improved gradually with supportive and conservative management.

Discussions: Dengue fever is a mosquito-borne flavivirus infection that can trigger systemic and post-infectious complications beyond the acute illness. Neuromuscular sequelae, though rare, include myositis and inflammatory neuropathies. This patient’s presentation—progressive proximal weakness with preserved reflexes, intact sensation, and normal CPK—distinguished her from classic Guillain-Barré syndrome. Imaging evidence of enthesopathy and inflammatory markers suggested a dengue-triggered autoimmune process, possibly seronegative spondyloarthropathy. A multidisciplinary team involving neurology, infectious disease, rheumatology, hematology, and PM&R was crucial in clarifying diagnosis, guiding treatment, and supporting functional recovery.

Conclusions: Dengue infection may precipitate prolonged weakness and inflammatory sequelae without typical myopathic enzyme elevation. Differentiating viral sequelae from autoimmune or demyelinating disease requires multidisciplinary evaluation, which is essential for optimizing diagnosis, management, and rehabilitation outcomes.