Myocarditis and Rhabdomyolysis in a Healthy Young Man Caused by Salmonella Gastroenteritis

Drug-resistant Salmonella Typhi induced kidney injury with rhabdomyolysis: A case report, and literature review

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AKI secondary to Salmonella Typhi can present with rhabdomyolysis.

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Patients may require temporary dialysis with a prolonged hospital stay.

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The prognosis of ST induced rhabdomyolysis is excellent.

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We present an extensive literature review of all reported ST bacteremia cases with AKI secondary to rhabdomyolysis.

Salmonella Typhi (ST) is a rod-shaped gram-negative bacterium that infects humans via contaminated food or water. Humans are the only reservoirs for the bacteria. Infection usually manifests as fever, abdominal pain, and diarrhea. However, complications such as intestinal perforation, hepatosplenomegaly, and renal injury can occasionally occur. Acute kidney injury (AKI) is associated more commonly with ST than other bacteria causing gastrointestinal (GI) infections. The exact pathophysiology of AKI in ST infection is unknown. One of the rarely reported mechanisms is rhabdomyolysis. We present a similar case of resistant ST infection leading to AKI with rhabdomyolysis. This article also contains an extensive literature reviews of all reported ST bacteremia cases with AKI secondary to rhabdomyolysis.

Epidemiologic and clinical profiles of bacterial myocarditis. Report of two cases and data from a pooled analysis

We aimed to characterize the epidemiology, diagnostic peculiarities and outcome determinants of bacterial myocarditis.

Two cases from our institution and literature reports were collected ending up with a total of 66 cases. In 37 (56%) patients, the diagnosis was confirmed by magnetic resonance and histopathological criteria. The other patients were classified as having possible myocarditis.

Only occurrence of rhythm disturbances was associated with the specific diagnosis of myocarditis (p = 0.04). Thirty-two (48%) patients presented with severe sepsis that was associated with a worse prognosis. At multivariate analysis, left ventricular ejection fraction (LVEF) at admission and heart rhythm disturbances were associated with incomplete recovery (odds ratio (OR) 1.1, 95% (CI) 1.03–1.2, p = 0.004 and OR 6.6, 95% CI 1.35–32.5, p = 0.02, respectively).

In summary, bacterial myocarditis is uncommon. Most commonly, it is secondary to septic dissemination of bacteria or to transient secondary myocardial toxicity.

Non-traumatic and non-drug-induced rhabdomyolysis

Rhabdomyolysis (RM), a fortunately rare disease of the striated muscle cells, is a complication of non-traumatic (congenital (glycogen storage disease, discrete mitochondrial myopathies and various muscular dystrophies) or acquired (alcoholic myopathy, systemic diseases, arterial occlusion, viral illness or bacterial sepsis)) and traumatic conditions. Additionally, RM can occur in some individuals under specific circumstances such as toxic substance use and illicit drug abuse. Lipid-lowering drugs in particular are capable of causing RM. This comprehensive review will focus on non-traumatic and non-drug-induced RM. Moreover, the pathology of RM, its clinical manifestation and biochemical effects, and finally its management will be discussed.

Application value of hypersensitive C-reactive protein, lactic acid and myoglobin in the combined detection of myocarditis

Application value of hypersensitive C-reactive protein (hs-CRP), blood lactic acid (LAC) and myoglobin (Mb) in the combined detection of myocarditis was explored. A total of 107 patients with suspected myocarditis treated in The Second Nanning People's Hospital from January 2015 to December 2017 were retrospectively analyzed, of whom 81 patients diagnosed with myocarditis were enrolled into the research group, and 26 non-myocarditis individuals were enrolled into the control group. Fasting venous blood was drawn from all patients to detect the hs-CRP, LAC and Mb, and their levels were compared and analyzed between the two groups. Moreover, the coincidence rate, sensitivity and specificity of single detection and combined detection by hs-CRP, LAC and Mb in the diagnosis of myocarditis were compared and analyzed. There were no significant differences in the sex, age, smoking status, alcohol consumption, chest distress, palpitation, angina and dyspnea between the two groups (P>0.05), proving that patients in both groups were comparable. The levels of hs-CRP, LAC and Mb in the research group were significantly higher than those in the control group, displaying statistically significant differences (P<0.05). According to the receiver operating characteristic (ROC) curve, the area under the curve (AUC), coincidence rate, sensitivity and specificity in the diagnosis of myocarditis, respectively, were 0.610 (95% CI: 0.495–0.725), 58.88, 51.85 and 80.77% for hs-CRP, 0.657 (95% CI: 0.551–0.763), 58.88, 54.32 and 73.08% for LAC, 0.747 (95% CI: 0.651–0.843), 69.16, 64.20 and 84.62% for Mb, and 0.773 (95% CI: 0.680–0.867), 76.64, 79.01 and 69.23% for combined detection. Hs-CRP, LAC and Mb are highly expressed in the serum of patients with myocarditis, and their combined detection has guiding significance for the prevention and treatment of myocarditis.

A Case Report of Salmonella muenchen Enteritis Causing Rhabdomyolysis and Myocarditis in a Previously Healthy 26-Year-Old Man

This case report examines an unusual presentation of a non-typhoidal Salmonella serovar with limited prevalence in the literature. This is the first case report to associate specifically the Salmonella muenchen serovar with rhabdomyolysis and myocarditis. This case report reviews the diagnostic criteria for myocarditis and explores the diagnostic dilemma of troponin elevation in the setting of rhabdomyolysis. It demonstrates that Salmonella muenchen has the ability to present in a broad range of individuals with complications extending beyond classical gastrointestinal symptoms. This report also concludes that diagnosis of the many possible complications from non-typhoidal Salmonella infections can be difficult due to patient comorbidities, variability in the severity of the illnesses, laboratory test limitations, and imaging limitations. When a patient presents with elevated troponins in the setting of rhabdomyolysis a careful workup should be done to evaluate for ischemic causes, myocarditis, or false elevation secondary to rhabdomyolysis.

Secondary myopathy due to systemic diseases

Background

Some systemic diseases also affect the skeletal muscle to various degrees and with different manifestations. This review aimed at summarizing and discussing recent advances concerning the management of muscle disease in systemic diseases.

Method

Literature review by search of MEDLINE, and Current Contents with appropriate search terms.

Results

Secondary muscle disease occurs in infectious disease, endocrine disorders, metabolic disorders, immunological disease, vascular diseases, hematological disorders, and malignancies. Muscle manifestations in these categories include pathogen‐caused myositis, muscle infarction, rhabdomyolysis, myasthenia, immune‐mediated myositis, necrotising myopathy, or vasculitis‐associated myopathy. Muscle affection may concern only a single muscle, a group of muscles, or the entire musculature. Severity of muscle affection may be transient or permanent, may be a minor part of or may dominate the clinical picture, or may be mild or severe, requiring invasive measures including artificial ventilation if the respiratory muscles are additionally involved. Diagnostic work‐up is similar to that of primary myopathies by application of non‐invasive and invasive techniques. Treatment of muscle involvement in systemic diseases is based on elimination of the underlying cause and supportive measures. The prognosis is usually fair if the causative disorder is effectively treatable but can be fatal in single cases if the entire musculature including the respiratory muscles is involved, in case of infection, or in case of severe rhabdomyolysis.

Conclusion

Secondary muscle manifestations of systemic diseases must be addressed and appropriately managed. Prognosis of secondary muscle disease in systemic diseases is usually fair if the underlying condition is accessible to treatment.