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Bilgin H, Bozaci AE. The evaluation of inherited metabolic diseases presenting with rhabdomyolysis from Turkey: Single center experience. Mol Genet Metab Rep 2024; 39:101070. [PMID: 38516404 PMCID: PMC10955420 DOI: 10.1016/j.ymgmr.2024.101070] [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: 02/12/2024] [Revised: 03/10/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024] Open
Abstract
Aim It was aimed to identify markers that would indicate which cases presenting with rhabdomyolysis are more likely to be associated with inherited metabolic diseases. Methods We analyzed 327 children who applied to our Hospital Pediatric Nutrition and Metabolic Diseases Clinic with rhabdomyolysis. The diagnosis of rhabdomyolysis was made by measuring the serum creatinine kinase level in cases presenting with muscle pain, weakness and dark urine. Results Metabolic disease was detected in 29 (16/13, M/F) patients from 26 different families. 298 patients (165/133, M/F) had normal metabolic work-up. We detected glutaric aciduria type 2 in 13 patients (44,6%), glycogen storage disease type 5 in three patients (10,3%), MCAD deficiency in three patients(10,3%), mitochondrial disease in three patients (10,3%), glycogen storage disease type 9 in one patient (3,5%), VLCAD deficiency in one patient (3,5%), LCHAD deficiency in one patient (3,5%), CPT2 deficiency in one patient(3,5%), Tango2 deficiency in one patient (3,5%), lipin-1 deficiency in one patient (3,5%) and primary carnitine deficiency in one patient (3,5%). Conclusion In our study, consanguineous marriage, developmental delay, and intellectual disability were found more frequently in patients with metabolic disease. In addition, CK levels above 2610 U/L was found to be significantly correlated with metabolic disease.
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Affiliation(s)
- Huseyin Bilgin
- Department of Pediatric Nutrition and Metabolism, Diyarbakir Children's Hospital, Diyarbakır, Turkey
| | - Ayse Ergul Bozaci
- Department of Pediatric Nutrition and Metabolism, Manisa City Hospital, Manisa, Turkey
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KC O, Dahal PH, Koirala M, NtemMensah AD. Rhabdomyolysis and Neurological Manifestation With Progressive Weakness in a Young Adult: A Rare Extrapulmonary Presentation of Mycoplasma Pneumoniae. Cureus 2021; 13:e20552. [PMID: 35103132 PMCID: PMC8770897 DOI: 10.7759/cureus.20552] [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: 12/20/2021] [Indexed: 12/03/2022] Open
Abstract
Mycoplasma pneumoniae (M. pneumoniae) is a common cause of community-acquired pneumonia. It has been associated with many extrapulmonary manifestations that can present even in the absence of pulmonary signs and symptoms. Rhabdomyolysis and central nervous system (CNS) manifestations are rare extrapulmonary manifestations. These are infrequently reported in adults. We present a case of a healthy 32-year-old male who initially presented with signs and symptoms of community-acquired pneumonia and was treated with antibiotics. However, he continued to have generalized malaise, night sweats, diffuse joint pain, and myalgias and was subsequently noted to have rhabdomyolysis with elevated creatine kinase (CK) and myoglobin levels. Rhabdomyolysis was attributed to M. pneumoniae based on the recent history of upper respiratory tract infection and M. pneumoniae immunoglobulin M (IgM) serology positivity along with high M. pneumoniae IgG titer. The other causes of rhabdomyolysis were diligently excluded based on patient history and laboratory and clinical data. This immune-mediated rhabdomyolysis improved with intravenous hydration, doxycycline, and prednisone therapy. However, the patient developed progressive weakness with neuropathy, which required treatment with intravenous immune globulin (IVIG). This case highlights the need to maintain a high index of suspicion for rare extrapulmonary manifestations of mycoplasma infection, which could be life-threatening or cause significant morbidity; and in cases of severe extrapulmonary manifestations, the appropriate use of immunosuppressive/immunomodulatory therapy may lead to a better outcome.
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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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Gulenay M, Sasson VA, Taylor K. Rhabdomyolysis: A Case Report of an Extrapulmonary Presentation of Mycoplasma pneumoniae. Clin Pract Cases Emerg Med 2021; 5:194-197. [PMID: 34437003 PMCID: PMC8143840 DOI: 10.5811/cpcem.2020.9.46024] [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] [Received: 11/28/2019] [Accepted: 09/20/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction We present an unusual case of rhabdomyolysis secondary to Mycoplasma pneumoniae in a healthy 27-year-old female. M. pneumoniae is associated with numerous extrapulmonary manifestations, including acute hepatitis, Stevens-Johnson syndrome, and rhabdomyolysis. Most documented cases affect the pediatric population, with only five cases in adults reported in the literature. Case Report The patient presented with complaints of myalgia and intractable cough. In this case the initial presentation demonstrated hypoxia requiring supplemental oxygen, and a creatine kinase of 7,646 units per liter (U/L) (reference range 26–192 U/L) with a peak of 29,427. During her hospitalization, she also remained persistently hypoxic for several days but ultimately was successfully weaned off all supplemental oxygen. She was discharged home after a seven-day hospitalization. Conclusion This patient’s presentation of an insidious, upper respiratory infection along with the subsequent development of rhabdomyolysis with reactive antibodies to M. pneumoniae demonstrates a link between these two clinically important conditions.
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Affiliation(s)
- Michael Gulenay
- St. Lucie Medical Center, Palm Beach Consortium for Graduate Medical Education, Department of Emergency Medicine, Port St. Lucie, Florida
| | - V Andres Sasson
- St. Lucie Medical Center, Palm Beach Consortium for Graduate Medical Education, Department of Emergency Medicine, Port St. Lucie, Florida
| | - Kevin Taylor
- St. Lucie Medical Center, Palm Beach Consortium for Graduate Medical Education, Department of Emergency Medicine, Port St. Lucie, Florida
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Gibson TB, Nguyen MD, Burrell T, Yoon F, Wong J, Dharmarajan S, Ouellet-Hellstrom R, Hua W, Ma Y, Baro E, Bloemers S, Pack C, Kennedy A, Toh S, Ball R. Electronic phenotyping of health outcomes of interest using a linked claims-electronic health record database: Findings from a machine learning pilot project. J Am Med Inform Assoc 2021; 28:1507-1517. [PMID: 33712852 DOI: 10.1093/jamia/ocab036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/19/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Claims-based algorithms are used in the Food and Drug Administration Sentinel Active Risk Identification and Analysis System to identify occurrences of health outcomes of interest (HOIs) for medical product safety assessment. This project aimed to apply machine learning classification techniques to demonstrate the feasibility of developing a claims-based algorithm to predict an HOI in structured electronic health record (EHR) data. MATERIALS AND METHODS We used the 2015-2019 IBM MarketScan Explorys Claims-EMR Data Set, linking administrative claims and EHR data at the patient level. We focused on a single HOI, rhabdomyolysis, defined by EHR laboratory test results. Using claims-based predictors, we applied machine learning techniques to predict the HOI: logistic regression, LASSO (least absolute shrinkage and selection operator), random forests, support vector machines, artificial neural nets, and an ensemble method (Super Learner). RESULTS The study cohort included 32 956 patients and 39 499 encounters. Model performance (positive predictive value [PPV], sensitivity, specificity, area under the receiver-operating characteristic curve) varied considerably across techniques. The area under the receiver-operating characteristic curve exceeded 0.80 in most model variations. DISCUSSION For the main Food and Drug Administration use case of assessing risk of rhabdomyolysis after drug use, a model with a high PPV is typically preferred. The Super Learner ensemble model without adjustment for class imbalance achieved a PPV of 75.6%, substantially better than a previously used human expert-developed model (PPV = 44.0%). CONCLUSIONS It is feasible to use machine learning methods to predict an EHR-derived HOI with claims-based predictors. Modeling strategies can be adapted for intended uses, including surveillance, identification of cases for chart review, and outcomes research.
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Affiliation(s)
- Teresa B Gibson
- Government Health and Human Services, IBM Watson Health, Bethesda, Maryland, USA
| | | | - Timothy Burrell
- Government Health and Human Services, IBM Watson Health, Bethesda, Maryland, USA
| | - Frank Yoon
- Government Health and Human Services, IBM Watson Health, Bethesda, Maryland, USA
| | - Jenna Wong
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Sai Dharmarajan
- Office of Biostatistics, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rita Ouellet-Hellstrom
- Division of Epidemiology II, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Wei Hua
- Food and Drug Administration, Silver Spring, Maryland, USA
| | - Yong Ma
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Elande Baro
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Sarah Bloemers
- Government Health and Human Services, IBM Watson Health, Bethesda, Maryland, USA
| | - Cory Pack
- Government Health and Human Services, IBM Watson Health, Bethesda, Maryland, USA
| | - Adee Kennedy
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Sengwee Toh
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Ball
- Office of Surveillance and Epidemiology Center for Drug Evaluation and Research U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Huan C, Xu Y, Zhang W, Guo T, Pan H, Gao S. Research Progress on the Antiviral Activity of Glycyrrhizin and its Derivatives in Liquorice. Front Pharmacol 2021; 12:680674. [PMID: 34295250 PMCID: PMC8290359 DOI: 10.3389/fphar.2021.680674] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/24/2021] [Indexed: 12/29/2022] Open
Abstract
Liquorice is a traditional medicine. Triterpenoids such as glycyrrhizin and glycyrrhetinic acid are the main active constituents of liquorice. Studies have revealed that these compounds exert inhibitory effects on several viruses, including SARS-CoV-2. The main mechanisms of action of these compounds include inhibition of virus replication, direct inactivation of viruses, inhibition of inflammation mediated by HMGB1/TLR4, inhibition of β-chemokines, reduction in the binding of HMGB1 to DNA to weaken the activity of viruses, and inhibition of reactive oxygen species formation. We herein review the research progress on the antiviral effects of glycyrrhizin and its derivatives. In addition, we emphasise the significance of exploring unknown antiviral mechanisms, structural modifications, and drug combinations in future studies.
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Affiliation(s)
- Changchao Huan
- Institutes of Agricultural Science and Technology Development, College of Veterinary Medicine, Yangzhou University, Yangzhou, China
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China
- Key Laboratory of Avian Bioproduct Development, Ministry of Agriculture and Rural Affairs, Yangzhou, China
| | - Yao Xu
- Institutes of Agricultural Science and Technology Development, College of Veterinary Medicine, Yangzhou University, Yangzhou, China
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China
- Key Laboratory of Avian Bioproduct Development, Ministry of Agriculture and Rural Affairs, Yangzhou, China
| | - Wei Zhang
- Institutes of Agricultural Science and Technology Development, College of Veterinary Medicine, Yangzhou University, Yangzhou, China
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China
- Key Laboratory of Avian Bioproduct Development, Ministry of Agriculture and Rural Affairs, Yangzhou, China
| | - Tingting Guo
- College of Medicine, Yangzhou University, Yangzhou, China
| | - Haochun Pan
- Institutes of Agricultural Science and Technology Development, College of Veterinary Medicine, Yangzhou University, Yangzhou, China
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China
- Key Laboratory of Avian Bioproduct Development, Ministry of Agriculture and Rural Affairs, Yangzhou, China
| | - Song Gao
- Institutes of Agricultural Science and Technology Development, College of Veterinary Medicine, Yangzhou University, Yangzhou, China
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China
- Key Laboratory of Avian Bioproduct Development, Ministry of Agriculture and Rural Affairs, Yangzhou, China
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Park EW, Shim YJ, Ha JS, Shin JH, Lee S, Cho JH. Diagnosis of Duchenne Muscular Dystrophy in a Presymptomatic Infant Using Next-Generation Sequencing and Chromosomal Microarray Analysis: A Case Report. CHILDREN-BASEL 2021; 8:children8050377. [PMID: 34064562 PMCID: PMC8151037 DOI: 10.3390/children8050377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/01/2021] [Accepted: 05/07/2021] [Indexed: 11/21/2022]
Abstract
Duchenne muscular dystrophy is a progressive and lethal X-linked recessive neuromuscular disease caused by mutations in the dystrophin gene. It has a high rate of diagnostic delay; early diagnosis and treatment are often not possible due to delayed recognition of muscle weakness and lack of effective treatments. Current treatments based on genetic therapy can improve clinical results, but treatment must begin as early as possible before significant muscle damage. Therefore, early diagnosis and rehabilitation of Duchenne muscular dystrophy are needed before symptom aggravation. Creatine kinase is a diagnostic marker of neuromuscular disorders. Herein, the authors report a case of an infant patient with Duchenne muscular dystrophy with a highly elevated creatine kinase level but no obvious symptoms of muscle weakness. The patient was diagnosed with Duchenne muscular dystrophy via next-generation sequencing and chromosomal microarray analysis to identify possible inherited metabolic and neuromuscular diseases related to profound hyperCKemia. The patient is enrolled in a rehabilitation program and awaits the approval of the genetic treatment in Korea. This is the first report of an infantile presymptomatic Duchenne muscular dystrophy diagnosis using next-generation sequencing and chromosomal microarray analysis.
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Affiliation(s)
- Eun-Woo Park
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University school of Medicine, Daegu 42601, Korea; (E.W.P.); (S.L.)
| | - Ye-Jee Shim
- Department of Pediatrics, Keimyung University Dongsan Hospital, Keimyung University school of Medicine, Daegu 42601, Korea;
| | - Jung-Sook Ha
- Department of Laboratory Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea;
| | - Jin-Hong Shin
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Korea;
| | - Soyoung Lee
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University school of Medicine, Daegu 42601, Korea; (E.W.P.); (S.L.)
| | - Jang-Hyuk Cho
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University school of Medicine, Daegu 42601, Korea; (E.W.P.); (S.L.)
- Correspondence: ; Tel.: +82-53-258-7912
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Coriell MB, Van Hersh AT, Shah S. Prolonged Seizure Activity Followed by Severe Hyperphosphatemia and Hypocalcemia in a Pediatric Patient. Cureus 2021; 13:e14338. [PMID: 33968541 PMCID: PMC8103793 DOI: 10.7759/cureus.14338] [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] [Indexed: 11/05/2022] Open
Abstract
Seizures secondary to hypocalcemia have been well documented and studied. There are various causes of hypocalcemia described in the literature, but a prolonged seizure episode leading to cell lysis, severe hyperphosphatemia, and hypocalcemia is rarely reported. We present the case of a 3-year-old male with severe hyperphosphatemia and hypocalcemia secondary to the likely presence of cell lysis from prolonged seizure activity. Our case illustrates the importance of a thorough evaluation of the possible differentials of hypocalcemia and hyperphosphatemia in a challenging presentation.
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Affiliation(s)
- Megan B Coriell
- Pediatric Endocrinology, University of Louisville School of Medicine, Louisville, USA
| | - Andrew T Van Hersh
- Pediatrics, University of Louisville School of Medicine, Louisville, USA
| | - Siddharth Shah
- Pediatric Nephrology, University of Louisville School of Medicine, Louisville, USA
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9
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Tong K, Yu GS. Acute recurrent rhabdomyolysis in a Chinese boy associated with a novel compound heterozygous LPIN1 variant: a case report. BMC Neurol 2021; 21:42. [PMID: 33514355 PMCID: PMC7844980 DOI: 10.1186/s12883-021-02050-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/07/2021] [Indexed: 01/04/2023] Open
Abstract
Background LPIN1-related acute recurrent rhabdomyolysis (RM), first reported in 2008, is an autosomal recessive inherited metabolic disease. In recent years, LPIN1 gene variants have been identified as one of the main causes of severe RM in children in Western countries. The disease is extremely rare in China, and we report a case of acute recurrent RM caused by a novel compound heterozygous LPIN1 variant. Case presentation A 15-year-old Chinese boy presented with myalgia after strenuous exercise, accompanied by transient increases in serum creatine kinase and myoglobin and persistent hyperuricaemia and hyperbilirubinaemia. Genetic analysis using high-throughput genomic sequencing and Sanger sequencing revealed that there was a compound heterozygous variant in the LPIN1 gene of the proband: the paternal c.2047A > G(p.I683V) was an unreported missense variant, and the maternal c.2107_2108 insAGG(p.Q703delin sQE) was an unreported in-frame variant. Conclusions In children with RM, LPIN1 variants should always be considered in the differential diagnosis. The clinical features of our case are atypical, which highlights the importance of an accurate diagnosis by genetic testing. If detected early, the condition may be controlled, and the prognosis may be improved.
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Affiliation(s)
- Ke Tong
- Department of Cardiovascular Disease, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders (Chongqing), 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China
| | - Geng-Sheng Yu
- Department of Cardiovascular Disease, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China. .,Ministry of Education Key Laboratory of Child Development and Disorders, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China. .,National Clinical Research Center for Child Health and Disorders (Chongqing), 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China. .,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China. .,Chongqing Key Laboratory of Pediatrics, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.
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Simoni C, Camozzi P, Faré PB, Bianchetti MG, Kottanattu L, Lava SAG, Milani GP. Myositis and acute kidney injury in bacterial atypical pneumonia: Systematic literature review. J Infect Public Health 2020; 13:2020-2024. [PMID: 33139236 DOI: 10.1016/j.jiph.2020.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Bacterial community-acquired atypical pneumonia is sometimes complicated by a myositis or by a renal parenchymal disease. Available reviews do not mention the concurrent occurrence of both myositis and acute kidney injury. METHODS In order to characterize the link between bacterial community-acquired atypical pneumonia and both myositis and a renal parenchymal disease, we reviewed the literature (United States National Library of Medicine and Excerpta Medica databases). RESULTS We identified 42 previously healthy subjects (35 males and 7 females aged from 2 to 76, median 42 years) with a bacterial atypical pneumonia associated both with myositis (muscle pain and creatine kinase ≥5 times the upper limit of normal) and acute kidney injury (increase in creatinine to ≥1.5 times baseline or increase by ≥27 μmol/L above the upper limit of normal). Thirty-six cases were caused by Legionella species (N = 27) and by Mycoplasma pneumoniae (N = 9). Further germs accounted for the remaining 6 cases. The vast majority of cases (N = 36) presented a diffuse myalgia. Only a minority of cases (N = 3) were affected by a calf myositis. The diagnosis of rhabdomyolysis-associated kidney injury was retained in 37 and that of acute interstitial nephritis in the remaining 5 cases. CONCLUSION Bacterial atypical pneumonia may occasionally induce myositis and secondary kidney damage.
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Affiliation(s)
- Chiara Simoni
- Università della Svizzera Italiana, Lugano, Switzerland
| | - Pietro Camozzi
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Pietro B Faré
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | | | - Lisa Kottanattu
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, and University of Lausanne, Lausanne, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
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11
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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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12
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Ivin N, Della Torre V, Sanders F, Youngman M. Rhabdomyolysis caused by carnitine palmitoyltransferase 2 deficiency: A case report and systematic review of the literature. J Intensive Care Soc 2019; 21:165-173. [PMID: 32489413 DOI: 10.1177/1751143719889766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Carnitine palmitoyltransferase 2 deficiency is an inherited metabolic disorder involving a deficiency in a mitochondrial enzyme necessary for long chain fatty acid oxidation, and therefore decreased utilisation of fatty acids. The adult form of this condition leads to recurrent rhabdomyolysis triggered by exercise, fasting and infection. It is a very rare condition with only a few hundred reported cases worldwide. Here we present a case of severe rhabdomyolysis in the context of carnitine palmitoyltransferase 2 deficiency in which major organ involvement was avoided, and organ support was not needed. This prompted us to perform a systematic review of the existing case reports in the literature to ascertain the most frequent patterns of organ involvement and assess the outcomes that are seen in these patients. Our findings suggest that these patients most frequently develop isolated renal failure, often requiring renal replacement therapy; however, the outcomes following this are very good, supporting the early involvement of intensive care teams.
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Affiliation(s)
- Nicholas Ivin
- Critical Care Unit, West Suffolk Hospital, NHS Foundation Trust, Bury St Edmunds, UK
| | - Valentina Della Torre
- Department of Critical Care, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Francis Sanders
- Critical Care Unit, West Suffolk Hospital, NHS Foundation Trust, Bury St Edmunds, UK
| | - Matthew Youngman
- Critical Care Unit, West Suffolk Hospital, NHS Foundation Trust, Bury St Edmunds, UK
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Abstract
Titin/connectin, encoded by the TTN gene, is the largest protein in humans. It acts as a molecular spring in the sarcomere of striated muscles. Although titin is degraded in the skeletal muscles of patients with muscular dystrophies, studies of titin have been limited by its mammoth size. Mutations in the TTN gene have been detected not only in skeletal muscle diseases but in cardiac muscle diseases. TTN mutations result in a wide variety of phenotypes. Recent proteome analysis has found that titin fragments are excreted into the urine of patents with Duchenne muscular dystrophy (DMD). Enzyme-linked immunosorbent assays (ELISAs) have shown that urinary titin is a useful noninvasive biomarker for the diagnosis and screening of not only DMD, but also of neuromuscular diseases, for predicting the outcome of cardiomyopathy and for evaluating physical activities. The development of ELISA systems to measure urinary titin has opened a door to studying muscle degradation directly and noninvasively. This review provides current understanding of urinary titin and future prospects for measuring this protein.
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Rabdomiólisis y daño renal agudo asociado a infección por Clostridium difficile, reporte de caso. Nefrologia 2019; 39:208-209. [DOI: 10.1016/j.nefro.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 06/12/2018] [Accepted: 07/31/2018] [Indexed: 11/22/2022] Open
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