1
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Putri A, Arunsodsai W, Hattasingh W, Sirinam S. DENV-1 infection with rhabdomyolysis in an adolescent: A case report and review of challenge in early diagnosis and treatment. Heliyon 2024; 10:e36379. [PMID: 39263171 PMCID: PMC11387269 DOI: 10.1016/j.heliyon.2024.e36379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 09/13/2024] Open
Abstract
Dengue infection is a well-known tropical disease that has become a global health issue. The clinical characteristics of dengue range from asymptomatic to severe, which can involve multiple organs and challenge management. Rhabdomyolysis in dengue infection is a rare condition described in children and adolescents. Herein, we present the case of a young adolescent with autism spectrum disorder who had a dengue virus serotype 1 infection complicated by rhabdomyolysis, which was not detected based on its typical manifestations. Rhabdomyolysis is recognized as one of the manifestations of expanded dengue syndrome and is associated with significant morbidity and mortality, especially if acute kidney injury develops. These coexisting conditions should be carefully considered, particularly in patients with underlying medical issues that may contribute to a worse prognosis. The early diagnosis and management of patients with dengue complicated by rhabdomyolysis is challenging and should be widely acknowledged. The detection of potential complications and appropriate fluid balance are essential to achieve a better prognosis.
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Affiliation(s)
- Anastasia Putri
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Watcharee Arunsodsai
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Weerawan Hattasingh
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Salin Sirinam
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
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2
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Pinto JM, Ison G, Kasselman LJ, Naganathan S. Acute Kidney Injury in Rhabdomyolysis: A 5-Year Children's Hospital Network Study. Healthcare (Basel) 2024; 12:1717. [PMID: 39273741 PMCID: PMC11395255 DOI: 10.3390/healthcare12171717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/15/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
Rhabdomyolysis is a skeletal muscle injury that can cause myoglobinuria and acute kidney injury (AKI). Risk factors for AKI in children are not clearly understood with no standardized treatment guidelines for rhabdomyolysis. Our study explores factors associated with AKI and management of pediatric patients with rhabdomyolysis. Medical records from a children's hospital network over a 5-year period were retrospectively reviewed. The results are described with respect to the presence or absence of AKI. Of the 112 patients who met the inclusion criteria, AKI incidence was 7.1% (n = 8), with all affected patients having exertional etiology. The overall mean age was 13.5 years; patients without AKI were younger than patients with AKI (13.3 versus 17; p < 0.001). Using regression models for hypothesis generation, we found that patients with AKI were more likely to be older (OR = 1.44, 95%CI [1.11-2.19]; p = 0.03), have myoglobinuria (OR = 22.98, 95%CI [2.05-432.48]; p = 0.02), and have received intravenous bicarbonate (OR = 16.02, 95%CI [1.44-228.69]; p = 0.03). In our study, AKI was uncommon and associated with older age, myoglobinuria and bicarbonate treatment. Larger, prospective studies are needed to further understand AKI risk factors and optimal management of pediatric rhabdomyolysis.
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Affiliation(s)
- Jamie M Pinto
- Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ 07753, USA
- Hackensack Meridian School of Medicine, 123 Metro Boulevard, Nutley, NJ 07110, USA
| | - Gregory Ison
- Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ 07753, USA
| | - Lora J Kasselman
- Hackensack Meridian Health Research Institute, 111 Ideation Way, Nutley, NJ 07110, USA
| | - Srividya Naganathan
- Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ 07753, USA
- Hackensack Meridian School of Medicine, 123 Metro Boulevard, Nutley, NJ 07110, USA
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3
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Chandrasekhar V, Singh H, Subramanian A, Dhibar DP, Suri V, Bhalla A. Rhabdomyolysis Due to Acute Alcohol Intoxication. Am J Med 2024; 137:e151-e152. [PMID: 38649000 DOI: 10.1016/j.amjmed.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Vishali Chandrasekhar
- Division of Clinical Infectious Diseases, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harpreet Singh
- Division of Clinical Infectious Diseases, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aravind Subramanian
- Division of Clinical Infectious Diseases, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deba Prasad Dhibar
- Division of Clinical Infectious Diseases, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Vikas Suri
- Division of Clinical Infectious Diseases, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Division of Clinical Infectious Diseases, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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4
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Denina M, Castagno E, Feyles F, Bruno I, Delmonaco AG, Peruzzi L, Bondone C. An unusual peak of febrile rhabdomyolysis. Minerva Pediatr (Torino) 2024; 76:294-295. [PMID: 37768644 DOI: 10.23736/s2724-5276.23.07346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- Marco Denina
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy -
| | - Francesca Feyles
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Ilaria Bruno
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Angelo G Delmonaco
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Licia Peruzzi
- Department of Pediatric Nephrology, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
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5
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Loy JS, Khoo CC, Arumugam T, Ngian GH, Ismail AK. Rhabdomyolysis due to unidentified jellyfish envenomation in west Malaysian waters. Toxicon X 2024; 21:100170. [PMID: 38021315 PMCID: PMC10654016 DOI: 10.1016/j.toxcx.2023.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Jellyfish envenomation is a common marine injury. We report a case of a 9-year-old boy who developed muscle weakness and rhabdomyolysis after a jellyfish sting. He was stung on the face, hands, and feet. He sustained immediate pain and numbness; however no immediate action was taken. He was taken to a primary health clinic and discharged with syrup Paracetamol 15mg/kg/dose and syrup Chlorpheniramine maleate 0.1mg/kg/dose for symptomatic relief. Over the next several days, the pain became generalized involving upper and lower limbs, aggravated by movement, and not alleviated by analgesia nor antihistamine. His condition worsened with the development of weakness of upper and lower limbs and 'tea-colored' urine from day 3 of illness. He received treatment for rhabdomyolysis at a district hospital. Maintaining hydration and urine output and symptomatic relief are central to treatment. His muscle pain and weakness improved. He was discharged well and remained asymptomatic at follow up.
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Affiliation(s)
- Jia Shyi Loy
- Pediatric Department, Sultanah Fatimah Specialist Hospital, Muar, Johore, Malaysia
| | - Chyi Chyi Khoo
- Pediatric Department, Sultanah Fatimah Specialist Hospital, Muar, Johore, Malaysia
| | - Tilagavahti Arumugam
- Pediatric Department, Sultanah Fatimah Specialist Hospital, Muar, Johore, Malaysia
| | - Geok Hoon Ngian
- Pediatric Department, Sultanah Fatimah Specialist Hospital, Muar, Johore, Malaysia
| | - Ahmad Khaldun Ismail
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Malaysia
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6
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Kara A. Adolescent Aripiprazole-Associated Rhabdomyolysis Without Neuroleptic Malignant Syndrome: A Case Report. J Clin Psychopharmacol 2023; Publish Ahead of Print:00004714-990000000-00139. [PMID: 37216377 DOI: 10.1097/jcp.0000000000001712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Aziz Kara
- Department of Child and Adolescent Psychiatry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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7
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Harmer MJ, Nijloveanu V, Thodi E, Ding WY, Longthorpe C, Fenton-Jones M, Hogg K, Day A, Platt C. Paediatric rhabdomyolysis: A UK centre's 10-year retrospective experience. J Paediatr Child Health 2023; 59:346-351. [PMID: 36504419 DOI: 10.1111/jpc.16303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/30/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022]
Abstract
AIMS To describe the aetiologies of paediatric rhabdomyolysis and explore the medium-term renal consequences. METHODS Retrospective, single-centre review of children with rhabdomyolysis. RESULTS Two hundred and thirty-two children met inclusion criteria for the analysis. Mean age at presentation was 8.4 (SD ± 5.5) years. The commonest aetiology was infection (28%), with viral myositis making up the clear majority (75%). Trauma was identified as a cause in 18% of children, seizures in 10% and immune-mediated mechanisms in 8%. Acute kidney injury (AKI) was present in 32% of the cases overall. Children with AKI tended to be younger, with higher peak creatine kinase (CK) and active urinary sediment on urinalysis at presentation. AKI and the need for renal replacement therapy (RRT) were associated with a prolonged hospital stay (15 (interquartile range, IQR 6.5-33) vs. 2 (IQR 0-7) days). A total of 18 children and young people required RRT, with a mean duration of 7.1 ± 4.3 days. Those who received RRT were more likely to have abnormalities on urinalysis at presentation (46% vs. 5%). Over the period of the study, 9% of children died and 2% met criteria for a diagnosis of chronic kidney disease. CONCLUSIONS This large paediatric rhabdomyolysis case series provides new and unique insights into the condition. Our results highlight the common aetiologies and provide evidence of good renal recovery overall, even in the most severely affected cases. Abnormalities of urinalysis appear to be important in predicting the development of AKI and the need for RRT.
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Affiliation(s)
- Matthew J Harmer
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom.,Department of Paediatric Nephrology, Southampton Children's Hospital, Southampton, United Kingdom
| | - Veronica Nijloveanu
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Eftychia Thodi
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Wen Y Ding
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Catherine Longthorpe
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Mary Fenton-Jones
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Kirstin Hogg
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Andrew Day
- University Hospital Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Caroline Platt
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
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8
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Mand N, Donath C, Leonhardt A, Weber S, Kömhoff M. Case report: Rhabdomyolysis in children in acute and chronic disease-a challenging condition in pediatric emergency medicine. Front Pediatr 2023; 11:1070465. [PMID: 36969298 PMCID: PMC10034202 DOI: 10.3389/fped.2023.1070465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/17/2023] [Indexed: 03/29/2023] Open
Abstract
Rhabdomyolysis is a challenging condition in pediatric emergency departments (PED): It ranges from asymptomatic illness with isolated elevation of creatine kinase (CK) levels to a life-threatening condition associated with extreme elevations in CK, electrolyte imbalances, circulatory failure (CF), acute kidney injury (AKI), and multi-organ disease. Most common causes of rhabdomyolysis are viral myositis and trauma, hereditary metabolic myopathies must be considered when facing rhabdomyolysis in early childhood. We report two cases of severe rhabdomyolysis with CF in our PED, thereby summarizing first-line management of rhabdomyolysis.
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Affiliation(s)
- N. Mand
- Pediatric Intensive Care, Department of Pediatrics, Philipps-University Marburg, Marburg, Germany
- Correspondence: N. Mand
| | - C. Donath
- Pediatric Intensive Care, Department of Pediatrics, Philipps-University Marburg, Marburg, Germany
| | - A. Leonhardt
- Pediatric Intensive Care, Department of Pediatrics, Philipps-University Marburg, Marburg, Germany
| | - S. Weber
- Pediatric Nephrology, Department of Pediatrics, Philipps-University Marburg, Marburg, Germany
| | - M. Kömhoff
- Pediatric Nephrology, Department of Pediatrics, Philipps-University Marburg, Marburg, Germany
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9
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Geeting D, Alibrahim O, Patel M, Kumar R, Mallory P. COVID-19 and Severe Rhabdomyolysis Causing Acute Kidney Injury and Life-Threatening Hyperkalemia in a Pediatric Patient: a Case Report. SN COMPREHENSIVE CLINICAL MEDICINE 2023; 5:121. [PMID: 37073177 PMCID: PMC10090753 DOI: 10.1007/s42399-023-01453-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/20/2023]
Abstract
Though initially believed to primarily be a respiratory pathogen, the SARS-CoV-2 virus has manifested as a virus that has the potential to affect multiple organ systems causing a wide variety of disease and symptomatology. Children have been largely spared in comparison to adult morbidity and mortality; however, acute pediatric illness secondary to COVID-19 infection has become both more common and more serious. Here, we present a teenager with acute COVID-19 who presented to the hospital with profound weakness and oliguria and was discovered to have severe rhabdomyolysis causing life-threatening hyperkalemia and acute kidney injury. He required treatment with emergent renal replacement therapy in the intensive care unit. His initial CK was 584,886 U/L. Creatinine was 14.1 mg/dL and potassium was 9.9 mmol/L. He was successfully treated with CRRT and was discharged on hospital day 13 with normal kidney function on follow-up. Rhabdomyolysis and acute kidney injury are increasingly recognized as complications of acute SARS-CoV-2 infection and require vigilance given the potentially fatal complications and long-standing morbidity associated with these conditions.
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Affiliation(s)
- Danielle Geeting
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children’s Hospital and Health System, Durham, NC USA
| | - Omar Alibrahim
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children’s Hospital and Health System, Durham, NC USA
| | - Mital Patel
- Division of Pediatric Nephrology, Department of Pediatrics, Duke Children’s Hospital and Health System, Durham, NC USA
| | - Reeti Kumar
- Division of Pediatric Nephrology, Department of Pediatrics, Duke Children’s Hospital and Health System, Durham, NC USA
| | - Palen Mallory
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children’s Hospital and Health System, Durham, NC USA
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10
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Kahraman AB, Karakaya B, Yıldız Y, Kamaci S, Kesici S, Simsek-Kiper PO, Kurt-Sukur ED, Bayrakcı B, Haliloglu G. Two tales of LPIN1 deficiency: from fatal rhabdomyolysis to favorable outcome of acute compartment syndrome. Neuromuscul Disord 2022; 32:931-934. [PMID: 36195520 DOI: 10.1016/j.nmd.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/03/2022] [Accepted: 06/24/2022] [Indexed: 12/31/2022]
Abstract
LPIN1 deficiency is an autosomal recessive disease caused by biallelic mutations in LPIN1, where impaired fatty acid metabolism leads to stress in skeletal muscle, resulting in severe rhabdomyolysis, often triggered by fever, exercise, fasting, and anesthesia. It is the second most common cause of severe, recurrent episodes of rhabdomyolysis in early childhood which can result in serious morbidity and mortality. To date, 71 patients have been published in 20 clinical studies in the form of case series. We describe two previously unreported cases, one with a novel LPIN1 mutation that resulted in mortality, and another, to the best of our knowledge, with the first reported compartment syndrome managed with a favorable outcome in this disorder. Recognition of the complications including ventricular arrythmias, acute renal failure and compartment syndrome on the severe end of the spectrum may change the outcome and prognosis of this devastating condition.
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Affiliation(s)
- Ayca Burcu Kahraman
- Department of Pediatrics, Division of Metabolism and Nutrition, Hacettepe University Faculty of Medicine, Ankara TR06230, Turkey.
| | - Bekir Karakaya
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yılmaz Yıldız
- Department of Pediatrics, Division of Metabolism and Nutrition, Hacettepe University Faculty of Medicine, Ankara TR06230, Turkey
| | - Saygin Kamaci
- Department of Orthopedics and Travmatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selman Kesici
- Division of Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Eda Didem Kurt-Sukur
- Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Benan Bayrakcı
- Division of Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Goknur Haliloglu
- Division of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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11
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Grover KM, Sripathi N. Prevention of Adverse Outcomes and Treatment Side Effects in Patients with Neuromuscular Disorders. Semin Neurol 2022; 42:594-610. [PMID: 36400111 DOI: 10.1055/s-0042-1758779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this article, we review prevention of serious adverse clinical outcomes and treatment side effects in patients with neuromuscular disorders including myopathies and myasthenia gravis. While neither of these entities is preventable, their course can often be modified, and severe sequelae may be prevented, with the identification of risk factors and proactive attention toward treatment planning.
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Affiliation(s)
- Kavita M Grover
- Department of Neurology, Henry Ford Medical Group, Wayne State University, Detroit, Michigan
| | - Naganand Sripathi
- Department of Neurology, Henry Ford Medical Group, Wayne State University, Detroit, Michigan
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12
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Kuok CI, Chan WKY. Motor Vehicle Collision and Acute Kidney Injury in Children. Pediatr Emerg Care 2022; 38:545-549. [PMID: 35916728 DOI: 10.1097/pec.0000000000002677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our study aimed to determine the prevalence of acute kidney injury (AKI) in pediatric patients who sustained trauma due to motor vehicle collision (MVC) and identify factors associated with its development. METHODS We retrospectively reviewed the clinical information and laboratory tests of pediatric patients who were admitted because of MVC from January 2014 to April 2021. The occurrence of AKI was our primary outcome, which was defined by the Kidney Disease Improving Global Outcomes criteria. A serum creatine kinase (CK) level of 1000 IU/L or greater was defined as rhabdomyolysis. RESULTS Sixty-four patients (median age, 9.6 years) were included in the study. Twenty three of the patients (35.9%) developed AKI: stage 1 AKI in 18 (78.3%) and stage 2 AKI in 5 (21.7%) patients. Acute kidney injury patients had higher injury severity scores (no AKI: 5.0; stage 1 AKI: 10.5; stage 2 AKI: 26.0). Rhabdomyolysis was present in 21.1% of the patients and was associated with the overall AKI risk (odds ratio [OR], 7.3; 95% confidence interval [CI], 1.6-32.6) and stage 2 AKI (OR, 15.0; 95% CI, 1.4-163.2). Blood tests from AKI patients showed lower serum bicarbonate and base excess, higher leukocyte and CK levels on admission, and a higher peak CK in the first 72 hours of admission. Intubation in emergency department (OR, 11.1; 95% CI, 1.2-102.1) and surgical interventions (OR, 3.2; 95% CI, 1.0-9.8) were associated with AKI. Acute kidney injury patients required longer stay in pediatric intensive care unit (median 1.0 vs 2.3 days, P < 0.001) and hospital (median 4.1 vs 7.0 days, P = 0.010). CONCLUSIONS Approximately one third of pediatric patients who sustained trauma from MVC developed AKI. Initial blood results, including higher CK and leukocyte count, and lower bicarbonate and base excess, were associated with the development of AKI. Rhabdomyolysis occurred in approximately one fifth of the patients and was significantly associated with AKI.
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13
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Huang D, Dluzneski S, Hughes M, Elbadri S, Ganti L. Dexmethylphenidate-Induced Rhabdomyolysis by Interaction With Aromatase Inhibitor. Cureus 2022; 14:e27988. [PMID: 36134084 PMCID: PMC9470210 DOI: 10.7759/cureus.27988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/05/2022] Open
Abstract
Rhabdomyolysis secondary to prescription drug-drug interactions can be an overlooked life-threatening emergency. Amphetamines and similar substances have been associated with muscle lysis secondary to increased sympathetic activity that can cause myotoxicity, hyperthermia, and increased muscular activity. Anabolic steroids may also be a predisposing factor in developing rhabdomyolysis. A high index of suspicion for drug-induced rhabdomyolysis in a patient presenting with atraumatic extremity pain can facilitate rapid diagnosis and treatment. We present a case of drug-induced rhabdomyolysis likely secondary to a previously unreported medication interaction.
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14
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Akıncı Göktaş Ö, Bektaş Ö, Öz Tunçer G, Birsin Özçakar Z, Talim B, Tuba Eminoğlu F, Teber S. A Rare Pediatric Case of Severe Rhabdomyolysis Owing to Dual Infection. KLINISCHE PADIATRIE 2022; 234:119-122. [PMID: 35255503 DOI: 10.1055/a-1486-7186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM We aimed to report a severe and rare pediatric rhabdomyolysis case associated with a dual viral infection. CASE A 13 year-old, healthy girl presented with the complaints of fever, abdominal pain, weakness and dark-colored urine. She was diagnosed with rhabdomyolysis based on clinical signs and laboratory findings. The diagnosis was confirmed by serological tests and real-time polymerase chain reaction for Epstein-Barr virus (EBV) and cytomegalovirus (CMV), respectively. Other potential genetic, metabolic and infectious causes were evaluated meticulously but no evidence was found. This case is also important as it is the first reported case to our knowledge on rhabdomyolysis associated with EBV and CMV co-infection in children. CONCLUSION The presented case experienced tetraplegia due to the severe muscular damage and muscle power returned to normal range after 3 months. This suggests that EBV and CMV may have exert synergistic effects leading to more severe inflammation and degeneration.
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Affiliation(s)
- Özben Akıncı Göktaş
- Department of child neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ömer Bektaş
- Department of child neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gökçen Öz Tunçer
- Department of child neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Birsin Özçakar
- Department of child nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Beril Talim
- Department of pediatric pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatma Tuba Eminoğlu
- Department of Pediatric Metabolic Disseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serap Teber
- Department of child neurology, Ankara University Faculty of Medicine, Ankara, Turkey
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15
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Gunn E, Fleisher S, Lebensburger J, Wolfson J. Altered mental status as a presentation of rhabdomyolysis in a patient with sickle cell anemia. Pediatr Blood Cancer 2022; 69:e29386. [PMID: 34709710 DOI: 10.1002/pbc.29386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Elizabeth Gunn
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sarah Fleisher
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey Lebensburger
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Julie Wolfson
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
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16
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Wilson JA, Hayden S, Asamoah A, Sharma VR, Jennings DC, Raj AB. Emicizumab Associated Rhabdomyolysis in Hemophilia A. Clin Hematol Int 2021; 2:165-167. [PMID: 34595457 PMCID: PMC8432407 DOI: 10.2991/chi.k.200924.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/16/2020] [Indexed: 11/06/2022] Open
Abstract
Emicizumab is increasingly the front-line treatment for patients with Hemophilia A with or without inhibitors. Rhabdomyolysis is a syndrome of muscle necrosis and release of intracellular muscle constituents into the circulation. Creatine kinase (CK) levels are typically markedly elevated, and muscle pain and myoglobinuria may be present. The severity of illness ranges from asymptomatic elevations in serum muscle enzymes to life-threatening disease associated with extreme enzyme elevations, electrolyte imbalances, acute kidney injury and disseminated intravascular coagulation. We present a case of an African American male with severe hemophilia A and history of factor VIII inhibitor, maintained on emicizumab prophylaxis, who developed rhabdomyolysis with a symptomatic hyperCKemia. To date, there is no known link between rhabdomyolysis to emicizumab. This report brings to light the possibility of symptomatic rhabdomyolysis as a potential side effect of emicizumab after moderate exertional activity.
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Affiliation(s)
- Joseph A Wilson
- Norton Children's Hospital, University of Louisville, Louisville, KY, USA
| | | | - Alexander Asamoah
- Department of Pediatrics, Division of Pediatric Genetics and Genomics, Norton Children's Hospital, University of Louisville, Louisville, KY, USA
| | - Vivek R Sharma
- Department of Medicine, Division of Medical Oncology/Hematology, University of Louisville, Louisville, KY, USA
| | - David C Jennings
- Department of Radiology, Pediatric Radiology Department, Norton Children's Hospital, Louisville, KY, USA
| | - Ashok B Raj
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Norton Children's Hospital, University of Louisville, Louisville, KY, USA
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Florou M, Lambropoulos V, Mouravas V, Kepertis C, Godosis D, Anastasiadis K, Kaselas C, Mavromatidis S, Spyridakis I. Crush syndrome in a case of severe infant physical abuse: a case report. Pan Afr Med J 2021; 39:172. [PMID: 34584598 PMCID: PMC8449563 DOI: 10.11604/pamj.2021.39.172.30309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 06/18/2021] [Indexed: 11/11/2022] Open
Abstract
Crush syndrome, also known as traumatic rhabdomyolysis, is the result of the disruption of skeletal muscle fibers with the release of intracellular contents into the bloodstream. Although trauma is the main trigger for rhabdomyolysis in adults, in the pediatric population viral infections and inherited disorders seem to be the most frequent causes. Only a few reports in the literature mention rhabdomyolysis secondary to non-accidental pediatric trauma. We herein report an unusual case of traumatic rhabdomyolysis, following significant physical abuse in an infant. Rhabdomyolysis should be suspected in children presenting with a history of excessive blunt trauma, because a prompt diagnosis and treatment prevent from the potential life-threatening consequences.
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Affiliation(s)
- Maria Florou
- Second Paediatric Surgery Department, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Vassilis Lambropoulos
- Second Paediatric Surgery Department, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Vasileios Mouravas
- Second Paediatric Surgery Department, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Chrysostomos Kepertis
- Second Paediatric Surgery Department, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Dimitrios Godosis
- Second Paediatric Surgery Department, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Kleanthis Anastasiadis
- Second Paediatric Surgery Department, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Christos Kaselas
- Second Paediatric Surgery Department, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Savvas Mavromatidis
- Operating Theaters, Surgical Sector, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Ioannis Spyridakis
- Second Paediatric Surgery Department, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
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18
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Gardner HM, Askenazi DJ, Hoefert JA, Helton A, Wu CL. Acute Kidney Injury Among Children Admitted With Viral Rhabdomyolysis. Hosp Pediatr 2021; 11:878-885. [PMID: 34301717 PMCID: PMC10118290 DOI: 10.1542/hpeds.2020-005108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Infectious etiologies cause a large portion of pediatric rhabdomyolysis. Among pediatric patients with rhabdomyolysis, it is unknown who will develop acute kidney injury (AKI). We sought to test the hypothesis that a viral etiology would be associated with less AKI in children admitted with rhabdomyolysis than a nonviral etiology. METHODS In this single-center retrospective cohort study, patients <21 years of age admitted with acute rhabdomyolysis from May 1, 2010, through December 31, 2018, were studied. The primary outcome was development of AKI, defined by using the Kidney Disease: Improving Global Outcomes guidelines. The primary predictor was identification of viral infection by laboratory testing or clinical diagnosis. Covariates included age, sex, race, insurance provider, presence of proteinuria and myoglobinuria, and initial creatinine kinase and serum urea nitrogen. Routine statistics and multivariable logistic modeling were performed via SAS 9.4 (SAS Institute, Inc, Cary, NC). RESULTS In total, 319 pediatric patients with rhabdomyolysis were studied. The median age was 13 years. Patients were predominately male (69.9%), non-Hispanic Black (55.2%), and publicly insured (45.1%). We found no difference in the rates of AKI in those with a viral diagnosis versus those without a viral diagnosis (30 of 77 [39.0%] vs 111 of 234 [47.4%]; P = .19). Multivariable analysis revealed that viral diagnosis was not associated with the development of AKI. Patients ≥13 years of age, male patients, and those with proteinuria and elevated serum urea nitrogen on admission had increased odds of developing AKI. CONCLUSIONS In our study, viral rhabdomyolysis did not have lower rates of AKI compared with nonviral etiologies of AKI; therefore, providers should consider continued caution in these patients.
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Affiliation(s)
- Hannah M Gardner
- Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
| | | | - Jennifer A Hoefert
- Division of General Academic Pediatrics, Section of Pediatric Hospital Medicine, Saint Louis University and Cardinal Glennon Children's Hospital, St Louis, Missouri
| | - Alexis Helton
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Chang L Wu
- Pediatric Hospital Medicine, Department of Pediatrics
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19
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Vallejo AN, Mroczkowski HJ, Michel JJ, Woolford M, Blair HC, Griffin P, McCracken E, Mihalik SJ, Reyes‐Mugica M, Vockley J. Pervasive inflammatory activation in patients with deficiency in very-long-chain acyl-coA dehydrogenase (VLCADD). Clin Transl Immunology 2021; 10:e1304. [PMID: 34194748 PMCID: PMC8236555 DOI: 10.1002/cti2.1304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 05/06/2021] [Accepted: 06/03/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Very-long-chain acyl-CoA dehydrogenase deficiency (VLCADD) is a disorder of fatty acid oxidation. Symptoms are managed by dietary supplementation with medium-chain fatty acids that bypass the metabolic block. However, patients remain vulnerable to hospitalisations because of rhabdomyolysis, suggesting pathologic processes other than energy deficit. Since rhabdomyolysis is a self-destructive process that can signal inflammatory/immune cascades, we tested the hypothesis that inflammation is a physiologic dimension of VLCADD. METHODS All subjects (n = 18) underwent informed consent/assent. Plasma cytokine and cytometry analyses were performed. A prospective case analysis was carried out on a patient with recurrent hospitalisation. Health data were extracted from patient medical records. RESULTS Patients showed systemic upregulation of nine inflammatory mediators during symptomatic and asymptomatic periods. There was also overall abundance of immune cells with high intracellular expression of IFNγ, IL-6, MIP-1β (CCL4) and TNFα, and the transcription factors p65-NFκB and STAT1 linked to inflammatory pathways. A case analysis of a patient exhibited already elevated plasma cytokine levels during diagnosis in early infancy, evolving into sustained high systemic levels during recurrent rhabdomyolysis-related hospitalisations. There were corresponding activated leukocytes, with higher intracellular stores of inflammatory molecules in monocytes compared to T cells. Exposure of monocytes to long-chain free fatty acids recapitulated the cytokine signature of patients. CONCLUSION Pervasive plasma cytokine upregulation and pre-activated immune cells indicate chronic inflammatory state in VLCADD. Thus, there is rationale for practical implementation of clinical assessment of inflammation and/or translational testing, or adoption, of anti-inflammatory intervention(s) for personalised disease management.
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Affiliation(s)
- Abbe N Vallejo
- Division of Pediatric Rheumatology, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Department of ImmunologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Children's Hospital of PittsburghUniversity of Pittsburgh Medical CenterPittsburghPAUSA
| | - Henry J Mroczkowski
- Children's Hospital of PittsburghUniversity of Pittsburgh Medical CenterPittsburghPAUSA
- Division of Genetic and Genomic Medicine, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Present address:
Department of PediatricsUniversity of Tennessee Health Sciences CenterMemphisTNUSA
| | - Joshua J Michel
- Division of Pediatric Rheumatology, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Michael Woolford
- Division of Pediatric Rheumatology, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Harry C Blair
- Department of PathologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Department of Cell BiologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Pittsburgh Veterans Administration Medical CenterPittsburghPAUSA
| | - Patricia Griffin
- Division of Pediatric Rheumatology, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Elizabeth McCracken
- Children's Hospital of PittsburghUniversity of Pittsburgh Medical CenterPittsburghPAUSA
- Division of Genetic and Genomic Medicine, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Center for Rare Disease and TherapyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Stephanie J Mihalik
- Division of Genetic and Genomic Medicine, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Department of PathologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Miguel Reyes‐Mugica
- Children's Hospital of PittsburghUniversity of Pittsburgh Medical CenterPittsburghPAUSA
- Department of PathologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Jerry Vockley
- Children's Hospital of PittsburghUniversity of Pittsburgh Medical CenterPittsburghPAUSA
- Division of Genetic and Genomic Medicine, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Center for Rare Disease and TherapyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Department of Human GeneticsUniversity of Pittsburgh Graduate School of Public HealthPittsburghPAUSA
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20
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Levetiracetam induced rhabdomyolysis. COGENT MEDICINE 2021. [DOI: 10.1080/2331205x.2021.1899575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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21
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Gilpin S, Byers M, Byrd A, Cull J, Peterson D, Thomas B, Jacobson P. Rhabdomyolysis as the Initial Presentation of SARS-CoV-2 in an Adolescent. Pediatrics 2021; 147:peds.2020-019273. [PMID: 33037123 DOI: 10.1542/peds.2020-019273] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 11/24/2022] Open
Abstract
The novel coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, has created a global pandemic, with many cases affecting the elderly. However, children have been affected as well, with ∼2.4% to 3.7% of cases reported. This case is the first published case of an adolescent presenting with rhabdomyolysis as the first sign of novel coronavirus disease 2019, with extremely elevated creatinine kinase levels, approaching almost 400 000 U/L. This case adds to the growing body of literature of a variety of life-threatening manifestations associated with severe acute respiratory syndrome coronavirus 2 infection and highlights the importance of how prompt recognition of these unique presentations of the disease is important to mitigate complications.
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Affiliation(s)
- Shawnese Gilpin
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois;
| | - Michael Byers
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Allison Byrd
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Jennifer Cull
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois; and
| | - Danielle Peterson
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois; and
| | - Bettina Thomas
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Phillip Jacobson
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois.,Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
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22
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Abstract
Severe acute respiratory syndrome coronavirus 2, the virus responsible of the current COVID-19 pandemic, has limited impact in the pediatric population. Children are often asymptomatic or present mild flu-like symptoms. We report the case of a COVID-19-infected adolescent presenting severe rhabdomyolysis and acute kidney injury without any fever or respiratory symptoms.
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23
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Abstract
Creatine kinase (CK) remains an essential tool for assessment of muscular weakness and pain in children despite the advent of advanced diagnostic tests in this field. It is also useful in diagnosing and monitoring various other conditions. This article will explore the physiology of CK and clinical situations where the estimation of CK can help the clinicians' decision-making process with the diagnosis and management of these conditions. Some clinical scenarios are used to highlight how the tests can be used in different clinical situations. The role of CK as a biomarker of myocardial injury has been purposefully omitted in this article.
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Affiliation(s)
- Tanmoy Chakrabarty
- Department of Paediatric Neurology, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Sandya Tirupathi
- Department of Paediatric Neurology, Belfast Health and Social Care Trust, Belfast, Belfast, UK
| | - Andrew Thompson
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
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24
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Abstract
Pediatric rhabdomyolysis is a common diagnosis that pediatricians need to be able to recognize because prompt treatment can prevent potential complications, such as acute kidney injury. The triggers for rhabdomyolysis are extensive, with viruses being the most common cause in pediatric patients. The pathophysiology behind rhabdomyolysis is complex and still being researched, but having a firm understanding of the cascade that results when muscle injury occurs is essential for proper management. Guidelines for managing pediatric rhabdomyolysis currently do not exist, but this article aims to review the available literature and give clinicians a general approach to aid in history taking, physical examination, diagnosis, acute management, follow-up, and prevention.
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Affiliation(s)
- Heidi S Szugye
- Cleveland Clinic Children's, Cleveland Clinic Lerner College of Medicine, Cleveland, OH
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25
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Yao Z, Yuan P, Hong S, Li M, Jiang L. Clinical Features of Acute Rhabdomyolysis in 55 Pediatric Patients. Front Pediatr 2020; 8:539. [PMID: 33014933 PMCID: PMC7500160 DOI: 10.3389/fped.2020.00539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 07/27/2020] [Indexed: 12/27/2022] Open
Abstract
Objective: This study was designed to compare the clinical manifestations, laboratory tests, etiology, and prognosis of children with acute rhabdomyolysis (RM) at various ages. This study was designed to analyze the risk factors for acute kidney injury (AKI) in children with RM and to identify the role of neuromuscular and autoimmune disease in children with RM. Methods: Clinical data for 55 children with RM were collected and statistically analyzed. Patients were stratified to an infant group (G1) (age <1 year), preschool group (G2) (age 1-6 year), school-age group (G3) (age 7-11 year), and an adolescent group (G4) (age 12-16 year). Results: The top three clinical manifestations were dark urine (52.7%), myalgia (38.2%), and fever (23.8%). Patients in G1 had fever (71.4%), vomiting (77.8%), and urinalysis abnormalities (14.3%), without triad clinical manifestations. Fifty percent of patients in G4 group had myalgia; 70.8% had dark urine; 75% had abnormal urine tests. The most common cause in each age group was as follows: sepsis (57.1%) in G1; hereditary neuromuscular diseases (44.4%) in G2; immune diseases (40%) in G3; strenuous exercise (50%) in G4. Logistic regression analysis shown that AKI was not corelated with age, gender, or peak creatine phosphokinase. AKI was, however, associated with presence of an electrolyte disorder. Conclusion: The clinical manifestations and laboratory findings in infants with acute RM are not typical and need to be taken seriously. The presence of an electrolyte disorder is a risk factor for AKI in children with RM. The most common pathogenesis of RM varies among age groups. Congenital hereditary metabolic disease and immune diseases should not be ignored as a cause of RM in children.
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Affiliation(s)
- Zhengxiong Yao
- Department of Neurology, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Yuan
- Department of Neurology, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Siqi Hong
- Department of Neurology, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Mei Li
- Department of Neurology, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Li Jiang
- Department of Neurology, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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26
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Suri NA, Meehan CW, Melwani A. A Healthy Toddler With Fever and Lethargy. Pediatrics 2019; 143:peds.2018-0412. [PMID: 30952780 DOI: 10.1542/peds.2018-0412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2018] [Indexed: 11/24/2022] Open
Abstract
A 21-month-old previously healthy girl presented to the emergency department initially with fever, rhinorrhea, and poor oral intake. She was subsequently discharged from the hospital on amoxicillin for treatment of acute otitis media but presented hours later on the same day with continued poor oral intake, decreased urine output, and lethargy. The patient was afebrile on examination without a focal source of infection or evidence of meningismus, but she was lethargic and minimally responsive to pain and had reduced strength in the upper and lower extremities. Initial laboratory analysis revealed leukocytosis with a neutrophil predominance and bandemia, hyponatremia, mild hyperkalemia, hyperglycemia, elevated transaminases, a mild metabolic acidosis, glucosuria, ketonuria, and hematuria. Follow-up tests, based on the history and results of the initial tests, were sent and led to a surprising diagnosis.
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Affiliation(s)
- Neha A Suri
- Department of Pediatrics, Children's National Health System, Washington, District of Columbia
| | - Colleen W Meehan
- Department of Pediatrics, Children's National Health System, Washington, District of Columbia
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27
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van 't Kruys K, Zonneveld R, Liesdek S, Zijlmans W. Rhabdomyolysis in Children: Three Exotic Presentations from Suriname. J Trop Pediatr 2019; 65:199-202. [PMID: 30085171 DOI: 10.1093/tropej/fmy043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We describe three clinical cases of Surinamese children with rhabdomyolysis with diverse clinical presentation and course. The first patient had rhabdomyolysis because of toxins caused by multiple beestings and developed acute kidney injury. The other two patients had rhabdomyolysis following acute infection with chikungunya and influenza A/H1N1 virus. These cases emphasize that the diverse etiology of rhabdomyolysis should be considered in children in tropical settings.
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Affiliation(s)
- Kevin van 't Kruys
- Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Rens Zonneveld
- Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Safir Liesdek
- Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Wilco Zijlmans
- Scientific Research Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname.,Anton de Kom University of Suriname, Paramaribo 9212, Suriname
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28
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Zayegh A, Lee J, Peters H, Efron D. A critically ill child with dark urine. Arch Dis Child Educ Pract Ed 2019; 104:15. [PMID: 29437759 DOI: 10.1136/archdischild-2017-314195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/29/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Amir Zayegh
- General Medicine Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Joy Lee
- Metabolic Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Heidi Peters
- Metabolic Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Daryl Efron
- General Medicine Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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29
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Park Y, Song JY, Kim SY, Kim SH. Clinical Characteristics of Rhabdomyolysis in Children : Single Center Experience. ACTA ACUST UNITED AC 2018. [DOI: 10.3339/jkspn.2018.22.2.52] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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30
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Wang L, Hong S, Huang H, Yang M. Rhabdomyolysis following status epilepticus with hyperuricemia: A case report and literature review. Medicine (Baltimore) 2018; 97:e11281. [PMID: 29953009 PMCID: PMC6039628 DOI: 10.1097/md.0000000000011281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Rhabdomyolysis owing to status epilepticus (SE) can be life-threating, with acute kidney injury (AKI) the most serious complication; therefore, early recognition of the risk factors is important. Hyperuricemia after epileptic seizures has been reported, and severe hyperuricemia can lead to acute renal function damage. PATIENT CONCERNS We present the case of a 21-year-old man hospitalized for SE, who had especially high level of blood uric acid (UA) at initial presentation. DIAGNOSIS The patient was diagnosed with rhabdomyolysis due to SE. INTERVENTIONS The patient was treated with hydration and bicarbonate therapy. But he developed acute kidney failure (AKF) and hemodialysis was performed. OUTCOMES After hemodialysis, his symptoms disappeared and laboratory data returned to normal. LESSONS Hyperuricemia after SE might indicate severe muscle damage or reduced clearance of metabolites, and could be a risk factor for kidney dysfunction, especially with rhabdomyolysis. To our knowledge, this is the first report of rhabdomyolysis following SE with hyperuricemia.
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31
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Hwang SD, Park KM, Lee SW, Han JY, Kim MJ, Song JH. Graft Contrast-Induced Nephropathy Caused by Prerenal Transplant Computed Tomography: A Case Report. Transplant Proc 2018; 50:1196-1198. [PMID: 29731093 DOI: 10.1016/j.transproceed.2018.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/22/2017] [Accepted: 01/22/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND We report a case of posttransplant contrast-induced nephropathy (CIN) that occurred after performing computed tomography (CT) scanning for pretransplant cardiac and vascular evaluation. CASE PRESENTATION The patient had an 8-year history of hemodialysis and was admitted to the hospital for a kidney transplant from a deceased donor. Cardiac CT imaging and 3-dimensional low-extremity CT angiography were performed to confirm the patient's cardiac and iliac artery function. After successful transplantation surgery, the patient had a urine output of 250 mL and a reduced creatinine level from 8.8 to 2.3 mg/dL on postoperative day 4. However, urine output suddenly decreased to 30 mL and the creatinine level suddenly increased to 7.6 md/dL without any symptoms such as fever or graft tenderness. The patient tested negative for panel-reactive antibodies and donor-specific antibodies, and he was discharged 1 week later with an improvement in symptoms. Results of a graft biopsy indicated CIN, and the contrast-enhanced kidney was observed on noncontrast CT imaging that was performed immediately after transplantation to rule out vascular problems as well as other complications. CONCLUSIONS There may be residual contrast present from pretransplant CT imaging, which could affect the functional kidney grafts after transplantation and can lead to CIN. This scenario could potentially lead to loss of graft function, suggesting that caution should be observed when ordering CT imaging in this patient population.
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Affiliation(s)
- S D Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - K-M Park
- Department of General Surgery, Inha University, Incheon, Republic of Korea
| | - S W Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - J-Y Han
- Department of Pathology, Inha University Hospital, Inha University Medical College, Incheon, Republic of Korea
| | - M-J Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - J H Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea.
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Almansour M, Alarifi S, Jarrar B. In vivo investigation on the chronic hepatotoxicity induced by intraperitoneal administration of 10-nm silicon dioxide nanoparticles. Int J Nanomedicine 2018; 13:2685-2696. [PMID: 29765215 PMCID: PMC5944457 DOI: 10.2147/ijn.s162847] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Silicon dioxide (silica) nanoparticles (SDNPs) are widely used in nanotechnology and medicine, but these nanomaterials may carry a high risk for human health while little is known about their toxicity. Methods We investigated the alterations in morphometry, biochemistry, hematology, histology of liver tissue and gene expression of drug-metabolizing enzymes induced by 10-nm SDNPs. Healthy male Wistar albino rats were exposed to 20, 35 and 50 repeated injections of SDNPs (2 mg/kg body weight). Whole blood, serum and plasma samples were used for hematological and biochemical analyses, whereas liver biopsies were processed for histopathological and gene expression alterations. Results In comparison with control rats, exposure to SDNPs lowered the body weight gain and liver index and increased the counts of white blood cells and platelets, but lowered the platelet larger cell ratio and plateletcrit. Levels of alkaline phosphatase, lactate dehydrogenase, low-density lipids, procalcitonin, aspartate aminotransferase and alanine aminotransferase, as well as potassium, phosphorus and iron concentrations, were increased. Histopathology revealed that SDNPs could induce hydropic degeneration, sinusoidal dilatation, hyperplasia of Kupffer cells, karyopyknosis and infiltration of inflammatory cells in the liver. SDNPs reduced the expression of 12 genes of drug-metabolizing enzymes significantly (p<0.05). Conclusion These results suggest that SDNPs could cause alterations in morphometry, biochemistry, hematology, liver tissues and the expression of drug-metabolizing enzyme genes.
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Affiliation(s)
- Mansour Almansour
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Saud Alarifi
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Bashir Jarrar
- Department of Biological Sciences, College of Science, Jerash University, Jerash, Jordan
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Tibana RA, Sousa NMFD, Cunha GV, Prestes J, Navalta JW, Voltarelli FA. Exertional Rhabdomyolysis after an Extreme Conditioning Competition: A Case Report. Sports (Basel) 2018; 6:E40. [PMID: 29910344 PMCID: PMC6026788 DOI: 10.3390/sports6020040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/07/2018] [Accepted: 04/23/2018] [Indexed: 02/06/2023] Open
Abstract
This case report describes an instance of exercise-induced rhabdomyolysis caused by an extreme conditioning program (ECP) competition. A 35-year-old female presented with abdominal pain and soreness, which began one day after she completed two days of ECPcompetition composed of five workouts. Three days after competition, creatine kinase (CK) was 77,590 U/L accompanied by myalgia and abnormal liver function tests, while renal function was normal and this resulted in a diagnosis of rhabdomyolysis. A follow-up examination revealed that her serum level of CK was still elevated to 3034 U/L on day 10 and 1257 U/L on day 25 following the ECP competition. The subject reported myalgia even up to 25 days after the ECP competition. Exertional rhabdomyolysis can be observed in ECP athletes following competition and highlights a dangerous condition, which may be increasing in recent years due to the massive expansion of ECP popularity and a growing number of competitions. Future research should investigate the causes of rhabdomyolysis that occur as a result of ECP, especially training methods and/or tasks developed specifically for these competitions.
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Affiliation(s)
- Ramires Alsamir Tibana
- Department of Physical Education, Universidade Federal de Mato Grosso (UFMT), Cuiabá 78000-000, Brazil.
- Graduation Program on Physical Education, Catholic University of Brasilia, Brasilia 72000-000, Brazil.
| | | | - Gabriel Veloso Cunha
- Undergraduate Program in Medicine, Catholic University of Brasilia, Brasilia 72000-000, Brazil.
| | - Jonato Prestes
- Graduation Program on Physical Education, Catholic University of Brasilia, Brasilia 72000-000, Brazil.
| | - James W Navalta
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA.
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Abstract
Rhabdomyolysis is an acute and potentially fatal syndrome characterized by striated muscle breakdown and subsequent release of muscle cell contents into the systemic circulation. The sudden release of large quantities of potassium, calcium, organic acids, and myoglobin into the bloodstream can cause renal tubal toxicity, cardiac dysrhythmias, and death. Complications can be managed and minimized if predicted and treated early, but patients may not have classic symptoms of rhabdomyolysis and may even be asymptomatic on presentation. This article reviews the pathophysiology, causes, diagnosis, and treatment of acute rhabdomyolysis.
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Affiliation(s)
- Henry Heard
- Henry Heard is an assistant clinical professor in the PA program at Mercer University in Atlanta, Ga. James Barker is on the hospitalist service at Emory Johns Creek Hospital in Johns Creek, Ga. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Lim YS, Cho H, Lee ST, Lee Y. Acute kidney injury in pediatric patients with rhabdomyolysis. KOREAN JOURNAL OF PEDIATRICS 2018; 61:95-100. [PMID: 29628970 PMCID: PMC5876511 DOI: 10.3345/kjp.2018.61.3.95] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/13/2017] [Accepted: 10/17/2017] [Indexed: 12/18/2022]
Abstract
Purpose This study aimed to evaluate the clinical findings in pediatric rhabdomyolysis and the predictive factors for acute kidney injury (AKI) in Korean children. Methods Medical records of 39 Korean children, who were newly diagnosed with rhabdomyolysis from January 2008 to December 2015, were retrospectively analyzed. The diagnosis was made from the medical history, elevated serum creatinine kinase level >1,000 IU/L, and plasma myoglobin level >150 ng/mL. Patients with muscular dystrophy and myocardial infarction were excluded. Results The median patient age at diagnosis was 14.0 years (range, 3–18 years), and the male to female ratio was 2.5. The most common presenting symptom was myalgia (n=25, 64.1%), and 14 patients (35.9%) had rhabdomyolysis-induced AKI. Eighteen patients (46.2%) had underlying diseases, such as epilepsy and psychotic disorders. Ten of these patients showed rhabdomyolysis-induced AKI. The common causes of rhabdomyolysis were infection (n=12, 30.7%), exercise (n=9, 23.1%), and trauma (n=8, 20.5%). There was no difference in the distribution of etiology between AKI and non-AKI groups. Five patients in the AKI group showed complete recovery of renal function after stopping renal replacement therapy. The median length of hospitalization was 7.0 days, and no mortality was reported. Compared with the non-AKI group, the AKI group showed higher levels of peak creatinine kinase and myoglobin, without statistical significance. Conclusion The clinical characteristics of pediatric rhabdomyolysis differ from those observed in adult patients. Children with underlying diseases are more vulnerable to rhabdomyolysis-induced AKI. AKI more likely develops in the presence of a high degree of albuminuria.
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Affiliation(s)
- Young Shin Lim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Taek Lee
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Yeonhee Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Shores DR, Everett AD. Children as Biomarker Orphans: Progress in the Field of Pediatric Biomarkers. J Pediatr 2018; 193:14-20.e31. [PMID: 29031860 PMCID: PMC5794519 DOI: 10.1016/j.jpeds.2017.08.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Darla R Shores
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Allen D Everett
- Division of Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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Mandato C, Rossi A, Caldore M, Lamba M, Rocco M, Auricchio R, Vajro P, Siani P. Rhabdomyolysis and coeliac disease: A causal or casual association? A case report and review of literature. Clin Res Hepatol Gastroenterol 2018; 42:e7-e13. [PMID: 28606713 DOI: 10.1016/j.clinre.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/05/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rhabdomyolysis is a rare, potentially life-threatening condition, caused by multiple disorders. The association with Coeliac Disease (CD) has been rarely reported and in these cases muscular damage was imputed to hypokalemia. Herein we describe a new case of severe rhabdomyolysis in a child subsequently diagnosed as affected by CD, and review previous reports. CASE PRESENTATION A 3-year-old boy was referred for diarrhea, brown urine, muscular pain/weakness, and no history of muscular trauma. At entry, laboratory tests showed elevated levels of creatine kinase (CK) (x100 unv) and aspartate aminotransferase (AST) (x10 unv), alanine aminotrasferase (ALT) (x5 unv); electrolytes were within the reference range. Twenty-four hours after admission serum CK peaked 115,000 U/L and transaminases increased up to 30 times unv. Hyperhydration treatment was started with renal function monitoring. Urine output decreased little, while serum creatinine and urea nitrogen stayed within the reference range. Serum potassium levels went down to 2.8 mEq/L at day 3, in spite of supplementation. The patient completely recovered at day 16. Main metabolic causes of rhabdomyolysis were ruled out by appropriate tests. Because of rarely reported cases of CD/rhabdomyolysis, anti-tissue transglutaminase (tTG) antibodies were measured and found positive (IgA 34 U/mL, unv <9). HLA typing was DQA1 05:02, DQB1 03:02. As jejunal biopsy showed patchy villous atrophy, gluten free diet (GFD) was prescribed. One year after starting GFD, histology was normal. REVIEW OF LITERATURE Literature (search engines: PUB MED and GOOGLE SCHOLAR) from 1980 to 2016 retrieved 8 cases (age range: 12 to 75 years old) previously described. CONCLUSION The present case suggests to check for CD in children with severe rhabdomyolysis. Because severe rhabdomyolysis itself may elevate the serum potassium levels, hypokalemia might go unrecognized as the cause of muscular damage.
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Affiliation(s)
- Claudia Mandato
- Department of Pediatrics, AORN Santobono-Pausilipon, via M. Fiore, 80129 Naples, Italy.
| | - Alessandro Rossi
- Department of Traslational Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Mariano Caldore
- Department of Pediatrics, AORN Santobono-Pausilipon, via M. Fiore, 80129 Naples, Italy
| | - Marta Lamba
- Department of Pediatrics, AORN Santobono-Pausilipon, via M. Fiore, 80129 Naples, Italy
| | - Michele Rocco
- Department of Services, Pathology, AORN Santobono-Pausilipon, via M. Fiore, 80129 Naples, Italy
| | - Renata Auricchio
- Department of Traslational Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Pietro Vajro
- Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, 84081, Baronissi (Salerno), Italy
| | - Paolo Siani
- Department of Pediatrics, AORN Santobono-Pausilipon, via M. Fiore, 80129 Naples, Italy
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Abstract
OBJECTIVES Rhabdomyolysis is a disorder of muscle breakdown. The aim of this study was to describe the epidemiology of rhabdomyolysis in children admitted to a PICU and to assess the relationship between peak creatinine kinase and mortality. DESIGN Retrospective cohort study in children admitted to the PICU with rhabdomyolysis between January 1, 2005, and December 31, 2014. Demographic, clinical, and outcome data were recorded. Outcomes were analyzed by level of peak creatinine kinase value (0-10,000, 10,001-50,000, > 50,000IU/L). Long-term renal outcomes were reported for PICU survivors. SETTING A single-centre academic tertiary PICU. PATIENTS Children admitted to the PICU with serum creatinine kinase level greater than 1,000 IU/L. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 182 children with rhabdomyolysis. The median peak creatinine kinase value was 3,583 IU/L (1,554-9,608). The primary diagnostic categories included sepsis, trauma, and cardiac arrest. Mortality for peak creatinine kinase values 0-10,000, 10,001-50,000, and > 50,000 IU/L were 24/138 (17%), 6/28 (21%), and 3/16 (19%), respectively (p = 0.87). Children with a peak creatinine kinase greater than 10,000 IU/L had a longer duration of mechanical ventilation and ICU length of stay than children with peak creatinine kinase less than 10,000. Renal replacement therapy was administered in 29/182 (16%). There was longer duration of mechanical ventilation (273 [141-548] vs. 73 [17-206] hr [p < 0.001]) and ICU length of stay (334 [147-618] vs. 100 [37-232] hr (p < 0.001)] in children receiving renal replacement therapy. Continuous veno-venous hemofiltration was the most common modality 23/29 (79%). Only one child required renal replacement therapy postintensive care stay, and adverse long-term renal outcomes were uncommon. CONCLUSIONS In children with rhabdomyolysis requiring intensive care, peak creatinine kinase was not associated with mortality but is associated with greater use of intensive care resources. Chronic kidney disease is an uncommon sequelae of rhabdomyolysis in children requiring intensive care.
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Attanasi M, Petrosino MI, Guidone PI, Rapino D, Comegna L, Rossi N, Blasetti A, Chiarelli F. A pediatric case of rhabdomyolysis with acute renal failure due to co-infection with Epstein-Barr virus and Human herpesvirus 6. Arch Med Sci 2018; 14:254-256. [PMID: 29379557 PMCID: PMC5778418 DOI: 10.5114/aoms.2016.61352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/28/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Marina Attanasi
- Department of Pediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | | | - Paola Irma Guidone
- Department of Pediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Daniele Rapino
- Department of Pediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Laura Comegna
- Department of Pediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Nadia Rossi
- Department of Pediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Annalisa Blasetti
- Department of Pediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
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Alaygut D, Torun Bayram M, Kasap B, Soylu A, Türkmen M, Kavukcu S. Rhabdomyolysis with different etiologies in childhood. World J Clin Pediatr 2017; 6:161-168. [PMID: 29184760 PMCID: PMC5691034 DOI: 10.5409/wjcp.v6.i4.161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/21/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate different etiologies and management of the rhabdomyolysis in children.
METHODS Eight pediatric rhabdomyolysis cases who applied to the Dokuz Eylul University Faculty of Medicine Department of Pediatric Nephrology with different etiologies between January 2004 and January 2012 were evaluated in terms of age, gender, admission symptoms, physical examination findings, factors provoking rhabdomyolysis, number of rhabdomyolysis attacks, laboratory results, family history and the final diagnosis received after the treatment.
RESULTS Average diagnosis ages of eight cases were 129 (24-192) ± 75.5 mo and five of them were girls. All of them had applied with the complaint of muscle pain, calf pain, and dark color urination. Infection (pneumonia) and excessive physical activity were the most important provocative factors and excessive licorice consumption was observed in one case. In 5 cases, acute kidney injury was determined and two cases needed hemodialysis. As a result of the further examinations; the cases had received diagnoses of rhabdomyolysis associated with mycoplasma pneumoniae, sepsis associated rhabdomyolysis, licorice-induced hypokalemic rhabdomyolysis, carnitine palmitoyltransferase II deficiency, very long-chain acyl-CoA dehydrogenase deficiency, congenital muscular dystrophy and idiopathic paroxysmal rhabdomyolysis (Meyer-Betz syndrome).
CONCLUSION It is important to distinguish the sporadic and recurrent rhabdomyolysis cases from each other. Recurrent rhabdomyolysis cases should follow up more regardful and attentive.
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Affiliation(s)
- Demet Alaygut
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Meral Torun Bayram
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Belde Kasap
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Alper Soylu
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Mehmet Türkmen
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Salih Kavukcu
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
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oğuz S, Tuygun N, Karacan CD. Enalapril ve essitalopram ile özkıyım girişimi sonrası gelişen rabdomiyoliz. EGE TIP DERGISI 2017. [DOI: 10.19161/etd.393483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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McArdle disease: a "pediatric" disorder presenting in an adult with acute kidney injury. CEN Case Rep 2017; 6:156-160. [PMID: 28660497 DOI: 10.1007/s13730-017-0265-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/26/2017] [Indexed: 12/18/2022] Open
Abstract
Rhabdomyolysis is characterized by the acute breakdown of skeletal muscle, resulting in the release of muscle cell contents, subsequent myoglobinuria, and in severe cases, acute renal failure. A number of etiologies have been identified in acute rhabdomyolysis, in which drugs and trauma account for the majority of cases. One etiological category that is commonly overlooked in the adult population is an underlying genetic defect. This may be challenging to diagnose due to its rarity in the adult demographic and the marked heterogeneity, often requiring a high level of clinical suspicion before investigation is pursued. Once diagnosed, however, appropriate steps can be taken to reduce future episodes of rhabdomyolysis, further renal injury, and other systemic complications. Here, we report a case of an adult patient presenting with acute rhabdomyolysis secondary to McArdle disease, a genetic disease causing defective glycogenolysis. The case highlights the importance of recognizing the potential of undiagnosed "pediatric" disorders in adulthood and particularly for underlying genetic causes of rhabdomyolysis.
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Acute kidney injury in symptomatic primary Epstein-Barr virus infectious mononucleosis: Systematic review. J Clin Virol 2017; 91:12-17. [DOI: 10.1016/j.jcv.2017.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/16/2017] [Accepted: 03/18/2017] [Indexed: 01/26/2023]
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Abstract
The purpose of this article is to present a discussion of a young adult patient with exertional rhabdomyolysis. Rhabdomyolysis is the process of muscle tissue destruction and damage to the cell membrane, with subsequent release of the intracellular myocyte contents into the systemic circulation. This leads to the potential for the life-threatening systemic complications of electrolyte abnormalities, cardiac dysrhythmias, acute kidney injury, compartment syndrome, and disseminated intravascular coagulopathy. Rhabdomyolysis as a syndrome can be difficult to recognize and diagnose in the emergency care setting due to the fact that there are many etiologies and variations in symptomatology. The emergency care provider must have an astute knowledge base of this disease process and consider this pathology in the differential diagnosis of any patient at risk to achieve optimum patient outcomes and reduce morbidity and mortality.
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Melek E, Bulut FD, Atmış B, Yılmaz BŞ, Bayazıt AK, Mungan NÖ. An ignored cause of red urine in children: rhabdomyolysis due to carnitine palmitoyltransferase II (CPT-II) deficiency. J Pediatr Endocrinol Metab 2017; 30:237-239. [PMID: 28085674 DOI: 10.1515/jpem-2016-0324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 11/17/2016] [Indexed: 11/15/2022]
Abstract
Carnitine palmitoyltransferase II (CPT-II) deficiency is an autosomal recessively inherited disorder involving the β-oxidation of long-chain fatty acids, which leads to rhabdomyolysis and subsequent acute renal failure. The clinical phenotype varies from a severe infantile form to a milder muscle form. Here, we report a 9-year-old boy referred to our hospital for the investigation of hematuria with a 2-day history of dark urine and malaise. As no erythrocytes in the microscopic examination of the urine and hemoglobinuria were present, myoglobinuria due to rhabdomyolysis was the most probable cause of dark urine. After excluding the other causes of rhabdomyolysis, with the help of metabolic investigations, the patient was suspected to have CPT-II deficiency, the most common cause of metabolic rhabdomyolysis. Our aim in presenting this case is to emphasize considering rhabdomyolysis in the differential diagnosis of dark urine in order to prevent recurrent rhabdomyolysis and renal injury.
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Basheer N, Mneimneh S, Rajab M. Seven-Digit Creatine Kinase in Acute Rhabdomyolysis in a Child. Child Neurol Open 2017; 4:2329048X16684396. [PMID: 28503623 PMCID: PMC5417286 DOI: 10.1177/2329048x16684396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 08/04/2016] [Accepted: 08/18/2016] [Indexed: 01/04/2023] Open
Abstract
Rhabdomyolysis is an acute life-threatening condition that can occur in childhood secondary to many causes. The authors report the case of a 3-year-old male child who presented with acute rhabdomyolysis. The peak plasma creatine kinase level was extremely high. The 2 main causes of rhabdomyolysis in childhood are viral myositis and trauma, which can sometimes lead to acute renal failure. The highest creatine kinase levels reported in the literature so far was a 6-digit level in 2014 case report. In this study, the authors report the case of a 7-digit creatine kinase level in a child secondary to viral myositis who did not require renal dialysis.
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Affiliation(s)
- Nuha Basheer
- Pediatric Department, Makassed General Hospital, Beirut, Lebanon.,Pediatric Department, Clemenceau Medical Center, Beirut, Lebanon
| | - Sirin Mneimneh
- Pediatric Department, Makassed General Hospital, Beirut, Lebanon.,Pediatric Department, Clemenceau Medical Center, Beirut, Lebanon
| | - Mariam Rajab
- Pediatric Department, Makassed General Hospital, Beirut, Lebanon.,Pediatric Department, Clemenceau Medical Center, Beirut, Lebanon
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Abstract
Rhabdomyolysis, which is a characteristic occurrence in associated with muscle cell necrosis, develops due to various causes. We herein report a rare case of a patient with rhabdomyolysis after high intensity resistance training, in which markedly elevated levels of serum creatine kinase (CK) and urine myoglobin were observed. A previously healthy 37-year-old man presented with severe myalgia and dark urine after performing high-intensity exercise. The patient's serum CK level was 95,100 U/L and his urine myoglobin level was 160,000 ng/mL. His symptoms and laboratory findings gradually improved with the intravenous administration of saline and no complications (including electrolyte imbalance and acute renal failure) developed.
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Affiliation(s)
- Sakiko Honda
- Department of Cardiology, Matsushita Memorial Hospital, Japan
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Comegna L, Guidone PI, Prezioso G, Franchini S, Petrosino MI, Di Filippo P, Chiarelli F, Mohn A, Rossi N. Pyomyositis is not only a tropical pathology: a case series. J Med Case Rep 2016; 10:372. [PMID: 28003031 PMCID: PMC5178088 DOI: 10.1186/s13256-016-1158-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 11/24/2016] [Indexed: 01/04/2023] Open
Abstract
Background Pyomyositis is an acute bacterial infection of skeletal muscle that results in localized abscess formation. This infection was thought to be endemic to tropical countries, and is also known as “tropical pyomyositis”. However, pyomyositis is increasingly recognized in temperate climates and is frequently associated with an immunosuppressive condition, such as human immunodeficiency virus, malignancy, and diabetes mellitus. It is also found in healthy and athletic people after strenuous or vigorous exercise or following localized and possibly unnoticed trauma. It can be primary or secondary to neighboring or remote infection. Primary pyomyositis is a rare condition that can affect children and adolescents. Diagnosis can be delayed because the affected muscle is deeply situated and local signs are not apparent. This delay in diagnosis can result in increased morbidity and a significant mortality rate. The pediatric population, which comprises 35% of the reported pyomyositis cases, is an especially difficult subset of patients to diagnose. Case presentation In our series, we describe the cases of four previously healthy Caucasian children who were admitted to our Pediatric Department with different clinical presentations. Pyomyositis in our patients was related to factors affecting the muscle itself, including strenuous exercise and direct muscle trauma. Therapy was started with a cephalosporin antibiotic and teicoplanin was subsequently added. The minimum length of therapy was 3 weeks. Conclusions The diagnosis of pyomyositis in our patients, none of whom were immune-compromised, is confirmation that this disease is not an exclusive pathology of tropical countries and demonstrates that there is an increasing prevalence of pyomyositis in temperate climates.
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Affiliation(s)
- Laura Comegna
- Department of Paediatrics, University of Chieti, Chieti, Italy.
| | | | | | | | | | | | | | - Angelika Mohn
- Department of Paediatrics, University of Chieti, Chieti, Italy.,University "G. D'Annunzio", Chieti, Italy
| | - Nadia Rossi
- Department of Paediatrics, University of Chieti, Chieti, Italy
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Sindoni A, Rodolico C, Pappalardo MA, Portaro S, Benvenga S. Hypothyroid myopathy: A peculiar clinical presentation of thyroid failure. Review of the literature. Rev Endocr Metab Disord 2016; 17:499-519. [PMID: 27154040 DOI: 10.1007/s11154-016-9357-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abnormalities in thyroid function are common endocrine disorders that affect 5-10 % of the general population, with hypothyroidism occurring more frequently than hyperthyroidism. Clinical symptoms and signs are often nonspecific, particularly in hypothyroidism. Muscular symptoms (stiffness, myalgias, cramps, easy fatigability) are mentioned by the majority of patients with frank hypothyroidism. Often underestimated is the fact that muscle symptoms may represent the predominant or the only clinical manifestation of hypothyroidism, raising the issue of a differential diagnosis with other causes of myopathy, which sometimes can be difficult. Elevated serum creatine kinase, which not necessarily correlates with the severity of the myopathic symptoms, is certainly suggestive of muscle impairment, though it does not explain the cause. Rare muscular manifestations, associated with hypothyroidism, are rhabdomyolysis, acute compartment syndrome, Hoffman's syndrome and Kocher-Debré-Sémélaigne syndrome. Though the pathogenesis of hypothyroid myopathy is not entirely known, proposed mechanisms include altered glycogenolytic and oxidative metabolism, altered expression of contractile proteins, and neuro-mediated damage. Correlation studies of haplotype, muscle gene expression and protein characterization, could help understanding the pathophysiological mechanisms of this myopathic presentation of hypothyroidism.
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Affiliation(s)
- Alessandro Sindoni
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy.
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, Via Consolare Valeria, 1, 98125, Messina, Italy.
| | - Carmelo Rodolico
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Simona Portaro
- IRCCS Centro Neurolesi "Bonino Pulejo", SS 113, Via Palermo, c.da Casazza, Messina, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Master Program on Childhood, Adolescent and Women's Endocrine Health, Messina, Italy
- Interdepartmental Program of Clinical and Molecular Endocrinology & Women's Endocrine Health, A.O.U. Policlinico "G. Martino", Messina, Italy
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