Original Research

Muscular Involvement in Dengue Fever: Clinical Spectrum and Pathophysiological Mechanisms

Adnan Munir1
Lady Reading Hospital, Peshawar
Salma Zeb1
Lady Reading Hospital, Peshawar
Abdul Majid1
Lady Reading Hospital, Peshawar
Hafsa Hafsa2
Peshawar Medical College, Peshawar

✉ Correspondence: Salma Zeb Email: salmazeb044@gmail.com

DOI https://doi.org/10.70302/jpsim.v7i3.2648
Volume: 7, Issue 3 Pages: 257–261 Published: 21 Aug 2026
Received: 23 Feb 2026 Revised: 03 Jun 2026 Accepted: 12 Aug 2026 Published Online: 21 Aug 2026

Abstract

Objectives

To determine the prevalence and clinical characteristics of muscular involvement in dengue infection, including myalgia, myositis, rhabdomyolysis, and hypokalaemic paralysis, by evaluating clinical presentations and laboratory parameters—particularly creatine phosphokinase (CPK) levels—in patients presenting to the outpatient department and those admitted to the dengue ward.

Methods

We conducted a prospective descriptive study including 75 patients with confirmed dengue fever. Demographic, clinical, and biochemical data were collected. Muscular involvement was classified as myalgia, myositis, rhabdomyolysis, or hypokalemic paralysis. Creatine phosphokinase (CPK) levels and other laboratory parameters were recorded. Associations were assessed using chi-square/Fisher’s exact tests, Mann–Whitney U test, and odds ratios with 95% confidence intervals.

Results

The mean age of participants was 36.8 ± 16.5 years; 70.7% were male. Elevated CPK was observed in 48.0% of patients. Rhabdomyolysis occurred exclusively in those with elevated CPK (22.2% vs. 0.0%; Fisher’s exact p = 0.0018; OR = 22.3, 95% CI 1.23–404.2). Muscle weakness was significantly more common in patients with elevated CPK (44.4% vs. 5.1%; χ² = 13.78, p < 0.001; OR = 14.8, 95% CI 3.09–70.95). No significant association was found between CPK status and self-reported muscle pain (p = 0.968). No participants exhibited electrolyte imbalance.

Conclusion

Muscular complications, including rhabdomyolysis and weakness, are significantly associated with elevated CPK in dengue fever. Routine CPK monitoring may help in early detection of severe muscular involvement. Larger, multicenter studies are warranted.

Keywords
Dengue fever Myositis Rhabdomyolysis Creatinine Phosphokinase.

How to Cite This Article

Munir A, Zeb S, Majid A, Hafsa H. Muscular Involvement in Dengue Fever: Clinical Spectrum and Pathophysiological Mechanisms. J Pak Soc Intern Med. 2026;7(3):257–261. doi:10.70302/jpsim.v7i3.2648

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Conflict of Interest

The authors declare no conflict of interest.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

This research received no specific grant from any funding agency.

Funder information follows the Crossref Funder Registry standard.

Ethics Statement

not_applicable

Conducted in accordance with the Declaration of Helsinki.

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Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2026 Journal of Pakistan Society of Internal Medicine.
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