Delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen: a case report

COVID-19-associated rhabdomyolysis: A scoping review

OBJECTIVES

SARS-CoV-2 infection ("COVID-19") and the hypoxemia that has attended some cases may predispose to rhabdomyolysis. We sought to identify reported cases of COVID-19-associated rhabdomyolysis, examining concurrent risk factors (RFs) and mortality outcomes.

METHODS

We searched PubMed for articles conveying individual-level information on COVID-19-associated rhabdomyolysis, published between January 2020 and July 2022, with an English-language abstract. Two independent parties performed the search, and then abstracted information on cases including rhabdomyolysis RFs and mortality.

RESULTS

In total, 117 individual reported cases of COVID-19-associated rhabdomyolysis were identified from 89 articles. A total of 80 cases (68.4%) had at least one reported non-COVID-19 RF (i.e. not considering COVID-19 or hypoxemia). On average, 1.27 additional RFs were reported, including age ≥65, metabolic syndrome features, hypothyroidism, previous rhabdomyolysis, hemoglobinopathy, trauma/compression, pregnancy, exertion, inborn errors of metabolism, concurrent (co-)infection, capillary leak syndrome, and selected rhabdomyolysis-associated medications. Concurrent RFs are understated, as many articles omitted comorbidities/medications. Of 109 cases with ascertainable survival status, 31 (28%) died.

CONCLUSIONS

COVID-19 and hypoxemia confer risk of rhabdomyolysis, but additional rhabdomyolysis RFs are commonly present. Mortality is substantial irrespective of the presence of such RFs. Clinicians should be aware of COVID-19-associated rhabdomyolysis, and caution may be warranted in administering agents that may amplify rhabdomyolysis risk.

Case Report: Etoposide-nedaplatin induced rhabdomyolysis in a small cell lung cancer patient

Rhabdomyolysis syndrome refers to the breakdown and necrosis of muscle tissue due to various reasons and caused by the release of intracellular contents into the blood stream, which can lead to acute renal failure or even death. In this article, we describe for the first time a case report of severe rhabdomyolysis induced by etoposide-nedaplatin chemotherapy in a small cell lung cancer (SCLC IIIb) patient. The patient developed progressive general muscle pain and weakness after the first cycle of chemotherapy, accompanied by elevated creatine kinase (CK), myoglobin (Mb), alanine aminotransferase (ALT), spartate aminotransferase (AST), and lactate dehydrogenase (LDH). Examination of and inquiry regarding the medical history were used to exclude various factors of rhabdomyolysis caused by trauma, strenuous activities, infections, drugs, hyperthermia, and immunity; the patient was diagnosed with severe rhabdomyolysis induced by chemotherapy. After treatment with intravenous fluids and methylprednisolone, the patient's symptoms were relieved and laboratory results were significantly improved. An unexpected situation arose, in that the lung CT scan showed that the lung mass was significantly smaller than that before chemotherapy; the reason for this is not clear. Rhabdomyolysis induced by anti-cancer drugs, especially chemotherapy drugs, is rarely reported and easily overlooked. Therefore, physicians should be aware of this rare but potentially serious complication when using chemotherapy drugs.

Electrolytes disturbances in cancer patients

PURPOSE OF REVIEW

Hypernatremia, hyperphosphatemia, hypocalcaemia, hyperkalaemia and hypermagnesemia are electrolytes disturbances that can arise in cancer patients in relation to unique causes that are related to the cancer itself or its treatment and can lead to delay or interruption of cancer therapy. This article summarizes these main causes, the proposed pathophysiology and the recommended management for these disturbances.

RECENT FINDINGS

There have been many cancer drugs approved in the field of oncology over the past several years and a subset of these drugs have been associated with electrolytes disturbances. This includes, for example, immune checkpoint inhibitor related hyperkalemia, fibroblast growth factor 23 inhibitor associated hyperphosphatemia and epidermal growth factor receptor inhibitor associated hypomagnesemia and hypocalcaemia.

SUMMARY

This article provides an updated review of certain electrolytes disturbance in cancer patients and allows clinicians to have a greater awareness and knowledge of these electrolyte abnormalities in efforts to early recognition and timely management.

Ifosfamide‐induced acute kidney injury in a patient with leiomyosarcoma: A case report

Background

Leiomyosarcoma (LMS) is an aggressive soft tissue sarcoma that is derived from smooth muscles. Ifosfamide is in use for advanced metastatic LMS.

Case

A‐44‐years old woman with a chief complaint of pain in the epigastric area, itching, coughing, nausea, and vomiting was referred to the emergency department. Her medical history was LMS. She had taken Ifosfamide and mesna in her last chemotherapy. Seventy percent of her liver and her left kidney were removed 4 years ago to prevent the progress of the disease. Because of the increase in the level of creatinine and urea in the initial laboratory report, a Shaldon catheter was inserted for the patient, and she was under emergency dialysis for 3 h. In addition, during the six‐day hospitalization period, dialysis was done two times. Finally, the patient was discharged with improved clinical tests accompanied by a twice‐weekly dialysis order.

Conclusion

Ifosfamide is metabolized into chloroacetaldehyde, which can cause acute kidney injury. Recovery from acute kidney injury may not always be perfect and can lead to some degree of chronic kidney disease. Opposite to hemorrhagic cystitis, mesna is not effective in preventing ifosfamide's nephrotoxicity and N‐acetylcysteine may be effective in the prevention of this nephrotoxicity.

Acute rhabdomyolysis in hepatitis-associated aplastic anemia patient undergoing allogeneic hematopoietic stem-cell transplantation: case report and literature review

Background

Hepatitis-associated aplastic anemia (HAAA) is a specific type of aplastic anemia, and hematopoietic stem-cell transplantation (HSCT) is recommended as the first-line. Acute rhabdomyolysis (AR) during hematopoietic stem-cell transplantation (HSCT) is a rare, serious complication, with only 10 cases reported in the world so far.

Case presentation

Herein, we present a case of AR developing during HLA-haploidentical HSCT in a 55-year-old man who suffered from HAAA. On day 7 after stem cell transfusion, the patient reported a muscle pull in thigh and complained of muscle swelling, pain and change in urine color. Despite the timely diagnosis (based on the levels of myoglobin and creatine kinase, and muscle MRI findings, etc.) and rapid hydration and alkalization, the situation progressed dramatically, and the patient died of multi-organ failure during the preparation for continuous renal replacement therapy (CRRT). Five days after his death, the whole-exome sequencing result confirmed that the patient had a germline missense mutation in SCN4A I 1545 V and ACTN3 R577X.

Conclusion

AR is a rare but threatening complication during HSCT, especially in cases with kidney dysfunction. The creatine kinase level may not truly and completely reflect the severity and prognosis for cases with localized lesion. We suggest that genetic analysis should be performed for better understanding the pathological changes of AR during HSCT, especially for patients with bone marrow failure.

Hypothyroidism as an immune-related adverse event caused by atezolizumab in a patient with muscle spasms: a case report

A 60-year-old man with a history of 4 cycles of atezolizumab treatment for non-small cell lung cancer presented to our hospital with a chief complaint of proximal muscle-dominant spasms. Blood tests showed elevated creatine phosphokinase (CPK) of 8450 U/L and hypothyroidism. There was little improvement even after stopping levetiracetam and pregabalin, and no subspinous physical findings of myositis. After levothyroxine was started for hypothyroidism, his muscle cramps and serum CPK level improved. Hypothyroidism as an immune-related adverse event can cause muscle spasms and is important in the differential diagnosis of muscle spasms in patients treated with immune checkpoint inhibitors.

Imaging side effects and complications of chemotherapy and radiation therapy: a pictorial review from head to toe

Newer biologic drugs and immunomodulatory agents, as well as more tolerated and effective radiation therapy schemes, have reduced treatment toxicity in oncology patients. However, although imaging assessment of tumor response is adapting to atypical responses like tumor flare, expected changes and complications of chemo/radiotherapy are still routinely encountered in post-treatment imaging examinations. Radiologists must be aware of old and newer therapeutic options and related side effects or complications to avoid a misinterpretation of imaging findings. Further, advancements in oncology research have increased life expectancy of patients as well as the frequency of long-term therapy-related side effects that once could not be observed. This pictorial will help radiologists tasked to detect therapy-related complications and to differentiate expected changes of normal tissues from tumor relapse.