Seven-Digit Creatine Kinase in Acute Rhabdomyolysis in a Child

Massively elevated creatine kinase levels in antihistamine-induced rhabdomyolysis

Rhabdomyolysis is the destruction of skeletal muscle tissue with release of intracellular components into the circulation. Elevation of creatine kinase levels in serum is indicative of muscle damage and is associated with acute kidney injury. Antihistamines are a rare cause of nontraumatic rhabdomyolysis. Herein we describe a case of intentional ingestion of diphenhydramine resulting in rhabdomyolysis with subsequent elevation in creatine kinase levels exceeding 2 million IU/L. Aggressive intravenous volume expansion rapidly lowered creatine kinase levels and improved renal function.

Long-term outcomes in a 25-year-old female affected with lipin-1 deficiency

Lipin-1 is a phosphatidic acid phosphohydrolase (EC 3.1.3.4) that catalyzes the dephosphorylation of phosphatidic acid to diacylglycerol and inorganic phosphate. Deficiency of this enzyme causes potentially fatal severe, recurrent episodes of rhabdomyolysis triggered by infection. The defect has only recently been recognized so little is known about the long-term outcome in adult patients with this disorder. We report the course and outcome of a 25-year-old female patient with lipin-1 deficiency after a recent episode of rhabdomyolysis requiring intensive care admission with a peak creatine kinase of 500 000 IU/L. One-year post discharge from intensive care, the patient has residual drop foot bilaterally consistent with bilateral common peroneal neuropathies in addition to a background residual distal myopathy.