[Acute rhabdomyolysis and primary human immunodeficiency virus type 1 infection: a new observation]

Blood urea nitrogen/creatinine ratio in rhabdomyolysis

Rhabdomyolysis, a potentially life-threatening syndrome, is not an uncommon condition with around 38,000 cases been reported in the USA in 2000. The risk of developing acute renal failure in the initial days of presentation can be as high as 40% and approximately 28-37% of patients require short-term hemodialysis. This report discusses a case of rhabdomyolysis after seizures in which blood urea nitrogen (BUN), creatinine, and BUN/creatinine levels were examined during the course of illness in the hospital. We found that the BUN/creatinine ratio is not a reliable indicator of renal function in rhabdomyolysis. Potassium levels can be a better marker for the early recognition of acute renal failure and an indication for prompt treatment with dialysis, which is crucial to prevent fatal complications.

Acute encephalopathy and multi-organ involvement with rhabdomyolysis during primary HIV infection

An adolescent male developed encephalopathy and multiple organ involvement with rhabdomyolysis during primary HIV infection (PHI). All symptoms and signs resolved within a few days. Nineteen cases of central nervous system complications (other than aseptic meningitis) have been reported in PHI. These include encephalopathy, meningoencephalitis, acute disseminated encephalomyelitis, multiple sclerosis, myelopathy, and meningoradiculitis. Half of the patients died or suffered sequelae. Except in cases of multiple sclerosis, steroids were not of benefit. Initiation of antiretrovirals during PHI remains controversial. Rhabdomyolysis was reported in eight patients with PHI. All patients recovered. Primary HIV infection should be considered when the clinician faces patients with unexplained neurologic manifestations, rhabdomyolysis, or multiple organ involvement.