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Akar HT, Yıldız Y, Mutluay R, Tekin E, Tokatlı A. Adult-onset carnitine palmitoyl transferase II (CPT II) deficiency presenting with rhabdomyolysis and acute kidney injury. CEN Case Rep 2024; 13:81-85. [PMID: 37341884 PMCID: PMC10982194 DOI: 10.1007/s13730-023-00804-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/22/2023] Open
Abstract
Metabolic myopathies are among the treatable causes of rhabdomyolysis and myoglobinuria. Carnitine palmitoyl transferase 2 (CPT II) deficiency is one of the most common causes of recurrent myoglobinuria in adults. It is an inherited disorder of fatty acid oxidation pathway, commonly associated with elevated acylcarnitine levels. In this case report, we present a 49-year-old male patient who developed acute kidney injury after rhabdomyolysis and was thus diagnosed with CPT2 deficiency after his first episode of rhabdomyolysis. Inborn errors of metabolism should be kept in mind in patients with rhabdomyolysis. Acylcarnitine profile may be normal in CPT II deficiency, even during an acute attack, and molecular genetic diagnostics should be applied if there is high index of clinical suspicion.
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Affiliation(s)
- Halil Tuna Akar
- Department of Pediatrics, Pediatric Metabolism Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Yılmaz Yıldız
- Department of Pediatrics, Pediatric Metabolism Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Rüya Mutluay
- Department of Internal Medicine, Nephrology Unit, Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Emel Tekin
- Department of Pathology, Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Ayşegül Tokatlı
- Department of Pediatrics, Pediatric Metabolism Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Denina M, Castagno E, Feyles F, Bruno I, Delmonaco AG, Peruzzi L, Bondone C. An unusual peak of febrile rhabdomyolysis. Minerva Pediatr (Torino) 2024; 76:294-295. [PMID: 37768644 DOI: 10.23736/s2724-5276.23.07346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- Marco Denina
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy -
| | - Francesca Feyles
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Ilaria Bruno
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Angelo G Delmonaco
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Licia Peruzzi
- Department of Pediatric Nephrology, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
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Finsterer J, Mehri S. Alternative etiologies of rhabdomyolysis must be ruled out before attributing it to bedding during surgery. Asian J Surg 2024; 47:1542-1543. [PMID: 38104009 DOI: 10.1016/j.asjsur.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
| | - Sounira Mehri
- Biochemistry Laboratory, LR12ES05 "Nutrition-Functional Foods and Vascular Health", Faculty of Medicine, Monastir, Tunisia.
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4
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Kamalaksha S, McGrath N, Low CS, Ghosh S. An uncommon case of rhabdomyolysis in severe hypothyroidism. N Z Med J 2024; 137:100-102. [PMID: 38386859 DOI: 10.26635/6965.6372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Sujatha Kamalaksha
- Consultant Physician and Rheumatologist, Whangārei Hospital, New Zealand; Senior Clinical Tutor, The University of Auckland, Health and Medical Sciences, New Zealand
| | | | | | - Sanjib Ghosh
- Consultant Physician and Rheumatologist, Whangārei Hospital, New Zealand; Senior Clinical Tutor, The University of Auckland, Health and Medical Sciences, New Zealand
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Pressman E, Osburn B, Vivas A, Krafft P, Ljubimov V, Chen L, Mhaskar R, Alikhani P. Rhabdomyolysis after spinal fusion surgery: management schema and prevention of a catastrophic complication. Br J Neurosurg 2024; 38:29-34. [PMID: 33410353 DOI: 10.1080/02688697.2020.1866164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Rhabdomyolysis is a clinical syndrome with the potential to cause cardiac arrhythmias, renal failure, and even death. Currently, there are no studies regarding risk factors for developing post-operative rhabdomyolysis (POR) after spinal fusion surgeries. Our objective was to study risk factors associated with, and to develop a decision-making framework for post-operative rhabdomyolysis after spinal fusion surgery. METHODS We performed a retrospective cohort study of all spinal fusions of three or more levels over 2.25 years by a single surgeon at two centers. POR was defined as a creatine phosphokinase (CPK) greater than 2000 IU/L. RESULTS 76 surgical procedures on 72 patients were identified. Rate of POR in our cohort was 22% (17/76). Male sex was associated with POR (p < 0.05). Previously validated risk factors: younger age, lower ASA score, elevated BMI, higher pre-operative creatinine, increased intraoperative blood loss, specific surgical positions, and length of surgery, were not associated with POR. In a logistic regression model, male gender increases the odds of POR in all patients 5.82-fold (p = 0.047). In patients without a second surgery within seven days, a logistic regression model suggests each additional level fused via transpsoas approach, and male gender, increases the risk of POR 1.81-times (p = 0.015), and 6.26-times (p = 0.047), respectively. In patients with posterior fusions, a logistic regression model suggests increasing the number of lateral levels fused via transpsoas approach in the same surgery, and male gender, increases the risk of POR 1.68-times and 6.34-times, respectively. In these same subgroups, increased thickness of the psoas major in lateral transpsoas fusions increased risk of POR (p = 0.023, p = 0.046, respectively). CONCLUSIONS In spinal fusions, increasing the number of lateral levels fused via transpsoas approach, and male gender, predispose patients to increased risk of POR in those without a second surgery within seven days, and in those with a simultaneous posterior fusion.
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Affiliation(s)
- Elliot Pressman
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Brooks Osburn
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Andrew Vivas
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Paul Krafft
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Vladimir Ljubimov
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Liwei Chen
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Puya Alikhani
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
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Hu YWE. Low Complex I and III Activity-Derived Myopathy Causing Recurrent Exertional Rhabdomyolysis. Curr Sports Med Rep 2024; 23:41-44. [PMID: 38315431 DOI: 10.1249/jsr.0000000000001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Yao-Wen Eliot Hu
- Department of Family and Community Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
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Yazıcı H, Ak G, Çelik MY, Erdem F, Yanbolu AY, Er E, Bozacı AE, Güvenç MS, Aykut A, Durmaz A, Canda E, Uçar SK, Çoker M. Experience with carnitine palmitoyltransferase II deficiency: diagnostic challenges in the myopathic form. J Pediatr Endocrinol Metab 2024; 37:33-41. [PMID: 37925743 DOI: 10.1515/jpem-2023-0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Carnitine palmitoyltransferase II (CPT II) deficiency is an autosomal recessive disorder of long-chain fatty acid oxidation. Three clinical phenotypes, lethal neonatal form, severe infantile hepatocardiomuscular form, and myopathic form, have been described in CPT II deficiency. The myopathic form is usually mild and can manifest from infancy to adulthood, characterised by recurrent rhabdomyolysis episodes. The study aimed to investigate the clinical features, biochemical, histopathological, and genetic findings of 13 patients diagnosed with the myopathic form of CPT II deficiency at Ege University Hospital. METHODS A retrospective study was conducted with 13 patients with the myopathic form of CPT II deficiency. Our study considered demographic data, triggers of recurrent rhabdomyolysis attacks, biochemical metabolic screening, and molecular analysis. RESULTS Ten patients were examined for rhabdomyolysis of unknown causes. Two patients were diagnosed during family screening, and one was diagnosed during investigations due to increased liver function tests. Acylcarnitine profiles were normal in five patients during rhabdomyolysis. Genetic studies have identified a c.338C>T (p.Ser113Leu) variant homozygous in 10 patients. One patient showed a novel frameshift variant compound heterozygous with c.338C>T (p.Ser113Leu). CONCLUSIONS Plasma acylcarnitine analysis should be preferred as it is superior to DBS acylcarnitine analysis in diagnosing CPT II deficiency. Even if plasma acylcarnitine analysis is impossible, CPT2 gene analysis should be performed. Our study emphasizes that CPT II deficiency should be considered in the differential diagnosis of recurrent rhabdomyolysis, even if typical acylcarnitine elevation does not accompany it.
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Affiliation(s)
- Havva Yazıcı
- Department of Inborn Errors of Metabolism, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Gunes Ak
- Department of Clinical Biochemistry, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Merve Yoldas Çelik
- Department of Inborn Errors of Metabolism, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Fehime Erdem
- Department of Inborn Errors of Metabolism, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Ayse Yuksel Yanbolu
- Department of Inborn Errors of Metabolism, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Esra Er
- Department of Inborn Errors of Metabolism, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Ayse Ergül Bozacı
- Department of Inborn Errors of Metabolism, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Merve Saka Güvenç
- Department of Medical Genetics, Tepecik Training and Research Hospital, Izmir, Türkiye
| | - Ayca Aykut
- Department of Medical Genetics, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Asude Durmaz
- Department of Medical Genetics, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Ebru Canda
- Department of Inborn Errors of Metabolism, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Sema Kalkan Uçar
- Department of Inborn Errors of Metabolism, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Mahmut Çoker
- Department of Inborn Errors of Metabolism, Ege University Faculty of Medicine, Izmir, Türkiye
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Putri A, Charoenwisedsil R, Techavachara N, Imad H, Chinpraditsuk S, Thaipadungpanit J, Matsee W. Severe leptospirosis with rhabdomyolysis in a traveller visiting Thailand. J Travel Med 2024; 31:taad161. [PMID: 38123495 DOI: 10.1093/jtm/taad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
We present a case of leptospirosis in a 32-year-old German who exhibited a progressing fever, calf pain complicated with acute kidney injury, and rhabdomyolysis following engagement in freshwater activities at a waterfall in Thailand. Fortunately, the patient made a full recovery without the need for renal replacement therapy.
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Affiliation(s)
- Anastasia Putri
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rachata Charoenwisedsil
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Narissara Techavachara
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Hisham Imad
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Travel Medicine Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sutatip Chinpraditsuk
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Janjira Thaipadungpanit
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wasin Matsee
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Travel Medicine Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Rixey AB, Glazebrook KN, Powell GM, Baffour FI, Collins MS, Takahashi EA, Tiegs-Heiden CA. Rhabdomyolysis: a review of imaging features across modalities. Skeletal Radiol 2024; 53:19-27. [PMID: 37318587 DOI: 10.1007/s00256-023-04378-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/16/2023]
Abstract
This review illustrates the imaging features of rhabdomyolysis across multiple modalities and in a variety of clinical scenarios. Rhabdomyolysis is the rapid breakdown of striated muscle following severe or prolonged insult resulting in the release of myocyte constituents into circulation. In turn, patients develop characteristically elevated serum creatine kinase, positive urine myoglobin, and other serum and urine laboratory derangements. While there is a spectrum of clinical symptoms, the classic presentation has been described as muscular pain, weakness, and dark urine. This triad, however, is only seen in about 10% of patients. Thus, when there is a high clinical suspicion, imaging can be valuable in evaluating the extent of muscular involvement, subsequent complications such as myonecrosis and muscular atrophy, and other etiologies or concurrent injuries causing musculoskeletal swelling and pain, especially in the setting of trauma. Sequela of rhabdomyolysis can be limb or life-threatening including compartment syndrome, renal failure, and disseminated intravascular coagulation. MRI, CT, ultrasound, and 18-FDG PET/CT are useful modalities in the evaluation of rhabdomyolysis.
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Affiliation(s)
- Allison B Rixey
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | | | - Garret M Powell
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Francis I Baffour
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Mark S Collins
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Edwin A Takahashi
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
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Tuchinsky A, Montalvo A, Lent D, Goldman J. Acute myositis secondary to Epstein-Barr virus in the absence of infectious mononucleosis with severe rhabdomyolysis. BMJ Case Rep 2023; 16:e256313. [PMID: 38103909 PMCID: PMC10728920 DOI: 10.1136/bcr-2023-256313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
SummaryRhabdomyolysis is characterised by muscle breakdown which causes myoglobin light chain release and can result in renal injury. While some of the most common causes of rhabdomyolysis are trauma related, others include toxins, autoimmune processes or viral aetiologies. We present the case of a 20s-year-old man, with no significant medical history, who presented to the emergency department with a 1-week history of weakness, myalgias, nausea, vomiting and subjective fevers. A review of systems and physical exam were otherwise unremarkable, including being negative for sore throat, dysphagia and lymphadenopathy. On presentation, the patient was noted to have dark urine with a creatine kinase value of 452 458 U/L and an elevated creatinine at 7.23 mg/dL. The patient denied any trauma or increased physical activity. His toxin screen and autoimmune workup were negative. The patient's serological workup was significant for acute Epstein-Barr virus (EBV) infection, without additional viral coinfection or mononucleosis. During his hospitalisation course, the patient was managed with supportive care including haemodialysis. The patient made a full renal recovery and was discharged with scheduled outpatient follow-up. This case highlights the recognition of an acute EBV infection causing rhabdomyolysis in the absence of mononucleosis or concomitant infection.
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Affiliation(s)
- Adam Tuchinsky
- Internal Medicine, UPMC-Lititz, Lititz, Pennsylvania, USA
| | | | - Dale Lent
- Internal Medicine, UPMC-Lititz, Lititz, Pennsylvania, USA
| | - John Goldman
- Division of Infectious Disease, UPMC-Harrisburg, Harrisburg, Pennsylvania, USA
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Dantas GHM, de Alkmim Moreira Nunes R, Casimiro-Lopes G, Neves EB, de Castro JBP, de Souza Vale RG. Analysis of physiological markers and risk factors for the development of rhabdomyolysis in military personnel: a systematic review. Rev Environ Health 2023; 38:613-620. [PMID: 35852130 DOI: 10.1515/reveh-2022-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To analyze case reports with individual patient data belonging to the Armed Forces submitted to specific physical or military combat training that was affected by rhabdomyolysis and identify factors that influenced the diagnosis and clinical evolution of the syndrome. CONTENT We conducted a systematic review following the PRISMA guidelines and registered on PROSPERO (CRD42021242465). We searched MedLine (via PubMed), Scopus, Cochrane, Lilacs, SciELO, CINAHL, Web of Science, SPORTDiscus, ScienceDirect, and PEDro databases for studies that reported cases of military personnel affected by rhabdomyolysis. SUMMARY AND OUTLOOK Thirteen studies met the inclusion criteria. Forty-nine individual cases of rhabdomyolysis were analyzed. From them, it was possible to identify several associated factors, which were responsible for developing rhabdomyolysis in military personnel. Thirty military personnel (60%) practiced physical training and 20 (40%) practiced specific military combat training. The creatine kinase (CK) peak ranged from 1,040 to 410,755 U/L, with an average of 44.991 U/L, and 14 (28%) of the cases reported alteration of renal function and four militaries (8%) evolved to death condition. Physical activities performed strenuously and without proper planning conditions such as room temperature, the period without adequate water intake, the amount of equipment used during the activity contributed to the development of rhabdomyolysis in the cases of military personnel analyzed in the present study. Therefore, it is recommended that future studies investigate the relationship between the prevalence of rhabdomyolysis cases and the severity of its consequence when associated with progressive methods of training, hydration control, acclimatization to austere environments, monitoring for the existence of hereditary diseases, and control of the use of supplementary nutritional substances.
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Affiliation(s)
- Guilherme Henrique Mattos Dantas
- Laboratory of Exercise and Sport (LABEES), Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Postgraduate Program in Exercise and Sport Sciences (PPGCEE), Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Rodolfo de Alkmim Moreira Nunes
- Laboratory of Exercise and Sport (LABEES), Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Postgraduate Program in Exercise and Sport Sciences (PPGCEE), Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Gustavo Casimiro-Lopes
- Postgraduate Program in Exercise and Sport Sciences (PPGCEE), Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
- Laboratory of Exercise Pathophysiology (LAFE), Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Eduardo Borba Neves
- Postgraduate Program on Biomedical Engineering (PPGEB), Federal Technological University of Paraná (UTFPR), Curitiba, PR, Brazil
| | - Juliana Brandão Pinto de Castro
- Laboratory of Exercise and Sport (LABEES), Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Postgraduate Program in Exercise and Sport Sciences (PPGCEE), Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Rodrigo Gomes de Souza Vale
- Laboratory of Exercise and Sport (LABEES), Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Postgraduate Program in Exercise and Sport Sciences (PPGCEE), Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
- Laboratory of Exercise Physiology, Estácio de Sá University, Cabo Frio, RJ, Brazil
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Huang Q, Shi Y, Xu J, Wang F, Li Y. Case Report: An Imported Case of Typhoid Fever Combined with Rhabdomyolysis and Multiple Organ Lesions in China. Am J Trop Med Hyg 2023; 109:1220-1222. [PMID: 37972323 DOI: 10.4269/ajtmh.22-0632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 08/14/2023] [Indexed: 11/19/2023] Open
Abstract
Here, we report a case of blood culture-confirmed typhoid fever, rhabdomyolysis, and multiple organ damage that arrived in our country from overseas. A 23-year-old male patient presented at our hospital with fever and muscle pain; the condition progressed rapidly. Six days after the onset of symptoms, the patient developed rhabdomyolysis and liver/kidney damage; levels of creatine kinase (CK; maximum peak: 729,869 U/L) and myoglobin (> 3,000 ng/mL) were extremely high, although the extent of renal damage was relatively mild. Blood culture showed Salmonella typhi. The patient received a combination of meropenem and levofloxacin anti-infective therapy, as well as fluid and nutritional metabolic support. He gradually recovered and was discharged after two negative blood cultures. This case highlights the fact that typhoid-induced rhabdomyolysis is a serious, life-threatening disease and that the levels of CK and myoglobin are useful indicators for evaluating typhoid-induced rhabdomyolysis. Clinicians should remain vigilant regarding travel-related illnesses associated with enteric fever.
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Affiliation(s)
- Qian Huang
- Department of Infectious Diseases, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yue Shi
- Department of Infectious Diseases, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingying Xu
- Department of Infectious Diseases, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fei Wang
- Department of Infectious Diseases, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yinghui Li
- Department of Infectious Diseases, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, China
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13
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Lu W, Li X, You W, Gong R. Rhabdomyolysis in a patient with end-stage renal disease and SARS-CoV-2 infection: A case report. Medicine (Baltimore) 2023; 102:e36360. [PMID: 38050193 PMCID: PMC10695608 DOI: 10.1097/md.0000000000036360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023] Open
Abstract
RATIONALE Rhabdomyolysis can be an uncommon complication of coronavirus disease 2019 (COVID-19) infection. However, the diagnosis of rhabdomyolysis could be easily missed due to its atypical clinical presentations. We present a patient with a history of end-stage renal disease (ESRD) who contracted COVID-19 and subsequently developed rhabdomyolysis. We discuss and share our experience in the management of this patient. PATIENT CONCERNS An 85-year-old male with ESRD undergoing routine hemodialysis was tested positive for COVID-19. The patient had clinical symptoms of fatigue, muscle pain, and difficulty walking. DIAGNOSIS The serum creatine kinase (CK) level was markedly elevated to 32,492.9U/L, supporting the diagnosis of rhabdomyolysis. A computed tomography scan revealed muscle injuries throughout the body, confirming the diagnosis. INTERVENTIONS The patient was managed through electrolyte corrections and continuous renal replacement therapy. OUTCOMES Repeat tests showed decreased levels of serum CK and negative severe acute respiratory syndrome coronavirus 2. His clinical symptoms, including fatigue and muscle pain, had significantly improved. LESSONS COVID-19 infection can cause muscle pain and fatigue, which can mask the symptoms of rhabdomyolysis. A missed diagnosis of rhabdomyolysis can be severe, especially in patients with ESRD. The serum CK level should be tested with clinical suspicion. Appropriate management, including adequate hydration and electrolyte balance, should be provided. Continuous renal replacement therapy should be considered in affected patients with renal insufficiency.
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Affiliation(s)
- Wenhui Lu
- Department of Nephrology and Oncology, The People’s Hospital of Yubei District of Chongqing, Chongqing, China
| | - Xiaoying Li
- Department of Nephrology and Oncology, The People’s Hospital of Yubei District of Chongqing, Chongqing, China
| | - Wenyi You
- Department of Nephrology and Oncology, The People’s Hospital of Yubei District of Chongqing, Chongqing, China
| | - Rui Gong
- Department of Nephrology and Oncology, The People’s Hospital of Yubei District of Chongqing, Chongqing, China
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Araújo D, Ferraz S, Pires JF, Paulino SG, Teixeira V, Marinho P, Rodrigues H. Rhabdomyolysis Due to Influenza Type B and RSV Type B Co-infection: A Clinical Case. Pediatr Infect Dis J 2023; 42:e494. [PMID: 37670464 DOI: 10.1097/inf.0000000000004075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Affiliation(s)
- Daniela Araújo
- Paedicatrics Department, Unidade Local de Saúde do Alto Minho. Viana do Castelo, Portugal
- Paedicatrics Department, Hospital de Braga. Braga, Portugal
| | - Sandra Ferraz
- Paedicatrics Department, Unidade Local de Saúde do Alto Minho. Viana do Castelo, Portugal
| | - Joana F Pires
- Paedicatrics Department, Centro Hospitalar Vila Nova de Gaia/Espinho. Vila Nova de Gaia, Portugal
| | - Sara Geraldes Paulino
- Paedicatrics Department, Centro Hospitalar e Universitário do São João. Porto, Portugal
| | - Vera Teixeira
- Dermatology Department, Unidade Local de Saúde do Alto Minho. Viana do Castelo, Portugal
| | - Pedro Marinho
- Paedicatrics Department, Unidade Local de Saúde do Alto Minho. Viana do Castelo, Portugal
| | - Hugo Rodrigues
- Paedicatrics Department, Unidade Local de Saúde do Alto Minho. Viana do Castelo, Portugal
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15
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Preger A, Wei R, Berg B, Golomb BA. COVID-19-associated rhabdomyolysis: A scoping review. Int J Infect Dis 2023; 136:115-126. [PMID: 37730012 DOI: 10.1016/j.ijid.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
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.
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Affiliation(s)
- Anna Preger
- Department of Medicine, University of California, San Diego
| | - Rebecca Wei
- Department of Medicine, University of California, San Diego; Current affiliation: University of California, Berkeley
| | - Brinton Berg
- Department of Medicine, University of California, San Diego
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Sever MŞ, Alper Katı Y, Özkaya U. Destructive disasters, trauma, crush syndrome, and beyond. Acta Orthop Traumatol Turc 2023; 57:305-314. [PMID: 38454211 PMCID: PMC10837607 DOI: 10.5152/j.aott.2023.23147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/15/2023] [Indexed: 03/09/2024]
Abstract
Orthopedic injuries, especially fractures of long bones as well as multiple fractures and comminuted fractures, are very common after destructive disasters (e.g., earthquakes, wars, and hurricanes). Another frequent problem is traumatic rhabdomyolysis, which may result in crush syndrome, the second most frequent cause of death after direct traumatic impact following earthquakes. To improve outcomes, interventions should be initiated even before extrication of the victims, which include maintenance of airway patency and spine stabilization, stopping traumatic bleeding by any means, and initiating fluid resuscitation. On-site amputations have been extensively debated to liberate the victims if the release of trapped limbs is impossible. Early after the rescue, a primary survey and triage are performed, a fluid resuscitation policy is planned, complications are treated, the wounds are decontaminated, and the victim is transported to specialized hospitals. A triage and primary survey are also performed at admission to the hospitals, which are followed by a secondary survey, physical, laboratory, and imaging examinations. Washing and cleaning of the soft-tissue injuries and debridement in open, necrotic wounds are vital. Applications of fasciotomies and amputations are controversial since they are associated with both benefits and serious complications; therefore, clear indications should be defined. Crush syndrome has been described as the presence of systemic manifestations following traumatic rhabdomyolysis, the most important component of which is acute kidney injury that may contribute to fatal hyperkalemia. The overall mortality rate is around 20% in crushed patients, which underlines the importance of prevention. Treatment includes maintaining of fluid electrolyte and acid-base balance, application of dialysis, and also prevention and treatment of complications. The principles and practices in disaster medicine may differ from those applied in routine practice; therefore, organizing repeated training courses may be helpful to provide the most effective healthcare and to save as many lives as possible after mass disasters.
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Affiliation(s)
- Mehmet Şükrü Sever
- Department of Nephrology, Istanbul University, School of Medicine, Istanbul, Turkey
| | - Yusuf Alper Katı
- Department of Orthopaedics and Traumatology, University of Health Sciences, Antalya Health Research Center, Antalya, Turkey
| | - Ufuk Özkaya
- Department of Orthopaedics and Traumatology, Bahçelievler Memorial Hospital, Istanbul, Turkey
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17
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Shiraishi W, Tateishi T, Hayashida S, Tajima G, Tsumura M, Isobe N. [A case of very long chain acyl-CoA dehydrogenase deficiency diagnosed due to a trigger of hyperemesis gravidarum during pregnancy]. Rinsho Shinkeigaku 2023; 63:656-660. [PMID: 37779023 DOI: 10.5692/clinicalneurol.cn-001854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
A 25-year-old Japanese woman with a history of repeated episodes of rhabdomyolysis since the age of 12 presented with rhabdomyolysis caused by hyperemesis gravidarum. Blood tests showed an elevated serum CK level (11,755 IU/l; normal: 30-180 IU/l). Carnitine fractionation analysis revealed low levels of total carnitine (18.3 μmol/l; normal: 45-91 μmol/l), free carnitine (13.1 μmol/l; normal: 36-74 μmol/l), and acylcarnitine (5.2 μmol/l; normal: 6-23 μmol/l). Tandem mass spectrometry showed high levels of C14:1 acylcarnitine (0.84 nmol/ml: normal: <0.4 nmol/ml) and a high C14:1/C2 ratio of 0.253 (normal: <0.013), indicating a potential diagnosis of very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency. Enzyme activity measurement in the patient's peripheral blood lymphocytes confirmed the diagnosis of VLCAD deficiency, with low palmitoyl-CoA dehydrogenase levels (6.5% of normal control value). With the patient's informed consent, acyl-CoA dehydrogenase very long-chain (ACADVL) gene analysis revealed compound heterozygous mutations of c.1332G>A in exon 13 and c.1349G>A (p.R450H) in exon 14. In Japan, neonatal mass screening is performed to detect congenital metabolic diseases. With the introduction of tandem mass screening in 2014, fatty acid metabolism disorders, including VLCAD deficiency, are being detected before the onset of symptoms. However, it is important to note that mass screening cannot detect all cases of this disease. For patients with recurrent rhabdomyolysis, it is essential to consider congenital diseases, including fatty acid metabolism disorders, as a potential diagnosis.
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Affiliation(s)
- Wataru Shiraishi
- Department of Neurology, Kokura Memorial Hospital
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Takahisa Tateishi
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | - Shotaro Hayashida
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Go Tajima
- Division of Neonatal Screening, Research Institute, National Center for Child Health and Development
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences
| | - Miyuki Tsumura
- Division of Neonatal Screening, Research Institute, National Center for Child Health and Development
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
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18
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McCann UG, Park T. Rhabdomyolysis in McArdle disease caused by scuba diving. BMJ Case Rep 2023; 16:e255192. [PMID: 37852664 PMCID: PMC10603480 DOI: 10.1136/bcr-2023-255192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
McArdle disease is a glycogen storage disease that results in rhabdomyolysis during intense exercise. A number of different triggers have been described. We evaluated a patient with McArdle disease who presented with rhabdomyolysis after recreational scuba diving. There was no concern for barotrauma or decompression sickness. His symptoms resolved with standard-of-care management for non-diving-related rhabdomyolysis. Features of his experience provoked questions about the diving-related factors contributing to his presentation. We present the case and explore possible mechanisms of diving-related injury in patients with McArdle disease, including the possible effects of hyperoxia, hyperbaria, hypothermia and strenuous activity.
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Affiliation(s)
- Ulysse George McCann
- Hospital Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Thomas Park
- Hospital Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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19
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Ali AA, Stemboroski L, Ravi M. Acute HIV presenting as rhabdomyolysis. BMJ Case Rep 2023; 16:e255621. [PMID: 37793847 PMCID: PMC10551877 DOI: 10.1136/bcr-2023-255621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
A man, in his early 30s, with no significant medical history presented with a 2-week history of fatigue, chest and abdominal pain, associated with anorexia and vomiting. Initial laboratory testing was suggestive of rhabdomyolysis with acute renal failure and transaminitis. The aetiology of his rhabdomyolysis initially remained unexplained as there were no clear risk factors or inciting events. An extensive workup revealed acute HIV as the precipitant of rhabdomyolysis.
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Affiliation(s)
- Aleem Azal Ali
- Gastroenterology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Lauren Stemboroski
- Gastroenterology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Malleswari Ravi
- Infectious Disease, University of Florida College of Medicine, Jacksonville, Florida, USA
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20
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Dias JV, Carvalho AA, Freixo JP, Antunes D, Martins AA, Painho T, Jacinto S. TANGO2 Deficiency Disorder: Two Cases of Developmental Delay Preceding Metabolic Crisis. Pediatr Neurol 2023; 147:52-55. [PMID: 37562170 DOI: 10.1016/j.pediatrneurol.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND TANGO2 deficiency disorder is a rare genetic disease caused by biallelic defects in TANGO2 gene. METHODS We report the clinical phenotype of two children with TANGO2 deficiency disorder. RESULTS Patient 1 is a female child presenting with developmental delay and microcephaly during the second year of life, who evolved with severe cognitive impairment, facial dysmorphisms, spastic paraparesis, and atonic seizures. At age 13 years, she was hospitalized due to an episode of rhabdomyolysis complicated with cardiac arrhythmia and hypothyroidism. Patient 2 is a female child with dysmorphic facial features, cleft palate, and developmental delay who was diagnosed with DiGeorge syndrome. At age three years, she presented with an acute episode of severe rhabdomyolysis in the context of human herpesvirus 6 infection. After the resolution of this acute episode, she maintained recurrent muscle weakness with axial hypotonia and progressive spasticity of the lower extremities. In both patients, diagnosis of TANGO2 deficiency disorder was only confirmed after an acute metabolic crisis. CONCLUSIONS A high index of suspicion for TANGO2 deficiency disorder is needed in patients with developmental delay or other neurological symptoms and episodic rhabdomyolysis.
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Affiliation(s)
| | - Ana Araújo Carvalho
- Pediatric Department, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - João Parente Freixo
- Center for Predictive and Preventive Genetics, Institute of Molecular and Cell Biology, Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Diana Antunes
- Medical Genetics Department, Centro Hospital Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Antunes Martins
- Pediatric Neurology Department, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Pediatric Neurology Unit, Hospital da Luz, Lisbon, Portugal
| | - Teresa Painho
- Pediatric Neurology Department, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Sandra Jacinto
- Pediatric Neurology Department, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
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21
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Sun K, Shi Z, Abudureheman Y, Liu Q, Zhao Y, Zhang X, Lv Q, Zhang Y, Shou S, Jin H. Clinical and Epidemiological Characteristics of Rhabdomyolysis: A Retrospective Study. Int J Clin Pract 2023; 2023:6396576. [PMID: 37808625 PMCID: PMC10558265 DOI: 10.1155/2023/6396576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023] Open
Abstract
Background Rhabdomyolysis (RM) refers to a clinical syndrome in which muscle cells are damaged by various causes and the clinical manifestations are mainly muscle pain, weakness, and dark urine. Acute kidney injury (AKI) is a serious complication of RM with complex mechanisms and high mortality. Therefore, understanding the pathogenesis and clinical manifestations, early diagnosis and treatment of RM are crucial to improve its prognosis. Method Analysis of medical records of RM patients admitted to Tianjin Medical University General Hospital from October 2019 to October 2022. Statistical software SPSS 25.0 was used to analyze the data. The risk factors of RM-complicated AKI were analyzed by logistic regression. The receiver operating characteristic (ROC) curve was plotted, the area under the curve (AUC) was calculated, and the optimal cutoff value was determined by the Youden index. P < 0.05 indicates a statistically significant difference between the groups. Result Among the 71 patients, the median age of the patients was 53.0 (30.0, 71.0) years and was 2.5 times higher in men than in women. Infection was the most common etiology. History of alcohol consumption, CK, and creatinine were independent influencing factors for AKI due to RM. Logistic regression analysis showed that CK combined with creatinine had a better predictive value than the single index. Conclusion Our study revealed the clinical and laboratory characteristics of RM in the population attending the Tianjin Medical University General Hospital in the last three years, which is a reference for future multicenter, prospective studies.
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Affiliation(s)
- Keke Sun
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhenhua Shi
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
- Department of Intensive Care Unit, PLA 983rd Hospital, Tianjin, China
| | - Yushanjiang Abudureheman
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
- Department of Critical Care Medicine, Hotan District People's Hospital, Xinjiang, China
| | - Qihui Liu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yibo Zhao
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiangqun Zhang
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Qi Lv
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Yan Zhang
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Songtao Shou
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Heng Jin
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
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22
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Paquot F, Jouret F. [Diagnostic approach to rhabdomyolysis]. Rev Med Liege 2023; 78:529-532. [PMID: 37712164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Rhabdomyolysis is a clinical syndrome related to the damage of skeletal muscle. The symptomatology is often poor, but it classically includes muscle weakness, myalgia and red-brown urine. The causes may be multiple but are most frequently traumatic : the so-called "crush syndrome". The diagnosis is based on the increase in serum creatine kinase, which is sometimes associated with myoglobinuria. Rhabdomyolysis may cause severe complications, such as ionic disorders or acute kidney injury which can lead to the death of the patient.
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Affiliation(s)
- François Paquot
- Service de Néphrologie, Dialyse et Transplantation, CHU Liège, Belgique
| | - François Jouret
- Service de Néphrologie, Dialyse et Transplantation, CHU Liège, Belgique
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23
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Corsa JG, Brown JO, Fleming RM, Bergmann RT, Henning JA, Monson JT. Wilderness Rescue of a Hiker with Multiple Trapped Limbs by a Combined Wilderness and Urban Rescue Team Using High-Pressure Airbags. Wilderness Environ Med 2023; 34:377-382. [PMID: 37468378 DOI: 10.1016/j.wem.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/29/2023] [Accepted: 05/16/2023] [Indexed: 07/21/2023]
Abstract
We report on the case of a 28-y-old man with both legs and left arm trapped for nearly 6 h after falling and subsequently being trapped by a boulder during a hike in the wilderness. Extrication required equipment designed for urban environments and was operated by an unconventional team of rescue professionals. The patient experienced multiple right lower-extremity orthopedic injuries, acute kidney injury secondary to rhabdomyolysis, and bilateral segmental pulmonary emboli. In this article, we detail the extrication and review the treatment guidelines for crush injuries that focus on aggressive fluid resuscitation prior to and during extrication and medication administration only if hyperkalemia presents. Wilderness rescuers should plan for the use of unconventional rescue equipment in austere prolonged rescue scenarios.
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Affiliation(s)
| | | | | | | | | | - Jeffrey T Monson
- Department of Surgery, Central Washington Hospital, Wenatchee, WA
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24
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Mohammad M, Alaoui-Ismaili Z, Arvig MD, Barzanji AF. [Not Available]. Ugeskr Laeger 2023; 185:V11220736. [PMID: 36896606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
We present a case report of rhabdomyolysis after intense physical activity. Tests showed increased creatine kinase compatible with rhabdomyolysis. Liver damage was suspected due to a significant elevation of aspartate transaminase (AST) and alanine transaminase (ALT). This case report discusses how an increase in AST and ALT reflects skeletal muscle damage in rhabdomyolysis instead of liver damage, especially when assessing more specific liver markers such as international normalised ratio and ϒ-glutamyl transferase, which both were within normal range in this case. This knowledge can prevent unnecessary test.
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Affiliation(s)
- Milan Mohammad
- Biomedicinsk Institut, Københavns Universitet
- SLEIPNER (Slagelse Emergency Medicine Point-of-Care Research Unit), Akutafdelingen, Københavns Universitetshospital - Slagelse Sygehus
| | | | - Michael Dan Arvig
- SLEIPNER (Slagelse Emergency Medicine Point-of-Care Research Unit), Akutafdelingen, Københavns Universitetshospital - Slagelse Sygehus
- Institut for Klinisk Medicin, Københavns Universitet
| | - Ayob Farouk Barzanji
- SLEIPNER (Slagelse Emergency Medicine Point-of-Care Research Unit), Akutafdelingen, Københavns Universitetshospital - Slagelse Sygehus
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25
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Pigeaud L, de Veld L, van der Lely N. Elevated creatinine kinase levels amongst Dutch adolescents with acute alcohol intoxication. Eur J Pediatr 2023; 182:1371-1375. [PMID: 36662269 PMCID: PMC10023758 DOI: 10.1007/s00431-023-04820-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/21/2023]
Abstract
This study aims to explore the prevalence of creatinine kinase elevation amongst a sample of Dutch adolescents admitted for acute alcohol intoxication. The data on all admitted adolescents < 18 years old with acute alcohol intoxication between 2008 and 2021 were collected from a Dutch major district general hospital, Reinier de Graaf Gasthuis, in Delft. Overall, 495 adolescents who were treated for symptoms of acute alcohol intoxication during this period were included in the study. When evaluating the blood samples of the included patients, elevated creatinine kinase levels were found in 60% of the cases, with a mean of 254 U/I (normal value ≤ 145 U/I). A confirmed diagnosis of rhabdomyolysis (increase in CK > fivefold the upper limit of normal) was present in 4.4% of cases. Moreover, using a linear regression this study found that a higher blood alcohol concentration was associated with higher creatinine kinase levels, when adjusted for positive drug screenings amongst the adolescents with acute alcohol intoxication (p = 0.027; β = 66.88; 95% CI 7.68 - 126.08). Conclusions: This is the first study focusing on how acute alcohol intoxication affects adolescents' muscle tissue. The results could potentially help to prevent alcohol use within the sports world. It could also aid understanding of how acute alcohol intoxication influences the breakdown of adolescents' muscle tissue. What is Known: • Alcohol, alongside pharmaceutical agents and illicit drugs, is a significant cause of rhabdomyolysis (increase in creatinine kinase > fivefold the upper limit of normal). • Creatinine kinase elevation in alcohol intoxicated patients may be as a result of direct "muscular" toxicity" (myotoxicity) or from prolonged immobilization and ischemic compression induced by coma. What is New: • Our retrospective cohort study is a pioneer in addressing the effect of acute alcohol intoxication amongst adolescents (< 18 years) upon muscle tissue (creatinine kinase level) within a large population. When evaluating the blood samples of the included population, elevated creatinine kinase levels were found in 60% of the cases, with a mean of 254 U/I (normal value ≤ 145 U/I). • There is an association between alcohol intoxication and elevated creatinine kinase levels amongst adolescents. Future research is needed to further understand the pathophysiology and causality of this interaction.
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Affiliation(s)
- Louise Pigeaud
- Department of Pediatrics, Reinier de Graaf Gasthuis, P.O. Box F5011, Delft, 2600 GA, The Netherlands.
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, 3062 PA, The Netherlands.
| | - Loes de Veld
- Department of Pediatrics, Reinier de Graaf Gasthuis, P.O. Box F5011, Delft, 2600 GA, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, 3062 PA, The Netherlands
| | - Nico van der Lely
- Department of Pediatrics, Reinier de Graaf Gasthuis, P.O. Box F5011, Delft, 2600 GA, The Netherlands
- Faculty of Medicine and Health Science, University Antwerp, Prinsstraat 1, Antwerp, 2000, Belgium
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Eichner ER. Team Rhadbo Rides Again - And Other News on Rhabdomyolysis. Curr Sports Med Rep 2023; 22:67-68. [PMID: 36866945 DOI: 10.1249/jsr.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Saroufim R, Alkotob S, Eugster EA. Rhabdomyolysis: A Rare Presentation of Hashimoto Thyroiditis in an Adolescent Boy and Review of the Literature. Horm Res Paediatr 2023; 96:538-541. [PMID: 36780885 DOI: 10.1159/000529673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION Hypothyroidism-induced rhabdomyolysis without precipitating factors is extremely rare, particularly in pediatric patients. We describe a previously healthy adolescent boy who came to our institution with vague symptoms and was found to have rhabdomyolysis secondary to hypothyroidism due to Hashimoto thyroiditis. We also summarize previously published cases in children and adolescents. CASE PRESENTATION A 16-year-old boy presented to the emergency department at Riley Hospital for Children with a 2-week history of bilateral eye and lip swelling, fatigue, and slowing of speech initially attributed to angioedema. His laboratory studies were significant for acute kidney injury secondary to rhabdomyolysis. Additional evaluation revealed profound primary hypothyroidism and positive TPO antibodies. Although his free T4 was undetectable, his TSH was only 32.2 mcU/mL. He received IV hydration and thyroid replacement, and his symptoms improved after several months of treatment. DISCUSSION Rhabdomyolysis without any risk factors is very rare, especially in children. Our patient was not on any medications, had no family history of neuromuscular disorders, and no history of trauma, infection, or strenuous exercise. The reason behind the disproportionately mild elevation of TSH in the setting of an undetectable free T4 is unclear. CONCLUSION It is important for clinicians to be aware that rhabdomyolysis may be a presenting sign of severe hypothyroidism, as delay in diagnosis and treatment can be detrimental.
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Affiliation(s)
- Rita Saroufim
- Pediatric Endocrinology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Shifaa Alkotob
- Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Erica A Eugster
- Pediatric Endocrinology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
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28
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Finsterer J, Scorza FA. Diagnosing SARS-CoV-2 vaccination-related rhabdomyolysis requires the exclusion of all differential causes. Pediatr Nephrol 2023; 38:1991-1992. [PMID: 36705756 PMCID: PMC9880909 DOI: 10.1007/s00467-023-05890-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 01/28/2023]
Affiliation(s)
| | - Fulvio A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
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29
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Afzal N. A Unique Case of Dark Brown Plasma: Why Colour Variation should be Reported. J Coll Physicians Surg Pak 2023; 33:60-62. [PMID: 37710942 DOI: 10.29271/jcpspcr.2023.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/15/2023] [Indexed: 09/16/2023]
Abstract
The normal physiological colour of plasma and urine ranges from yellow to straw-coloured. In this case report, we describe the occurrence of unusual, dark brown-coloured plasma and cola-coloured urine in a 42-year-man admitted to the Emergency Department. The patient presented with high-grade fever (102oF), chills, nausea, vomiting, dark stools, and dark urine for three days. The plasma was found to be dark brown in colour. He was diagnosed with Dengue hemorrhagic fever (DHF) and rhabdomyolysis (RM). He was closely monitored and treated successfully at our hospital. This case highlights the importance of plasma colour variations and also sheds light on a rare cause of dark brown-coloured plasma. Every case of brown colouration of the plasma must be promptly reported to the clinician and must also be mentioned in the patient report as this will help in timely diagnosis and favourable patient outcomes. Key Words: Blood plasma, Urine, Dengue fever, Rhabdomyolysis.
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Affiliation(s)
- Nayab Afzal
- Department of Laboratory Medicine, National Medical Centre, Karachi, Pakistan
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30
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Madireddy N, Swain M, Yalamarty R. Myoglobin cast nephropathy following multiple bee stings. INDIAN J PATHOL MICR 2023; 66:177-179. [PMID: 36656236 DOI: 10.4103/ijpm.ijpm_981_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Bee stings usually result in mild allergic reactions; however, mass envenomation can cause severe complications such as rhabdomyolysis, hemolysis, shock, or multi-organ damage. Rhabdomyolysis can result in acute renal failure either by tubular obstruction by myoglobin casts or by direct cytotoxic injury. We present a case of a 12-year-old female child who presented with sudden onset anuria and hypertension following mass envenomation by bees. A renal biopsy was performed, the microscopic evaluation of which revealed tubular injury, with associated intratubular pigmented casts. The casts stained positive for myoglobin immunohistochemical stain, thus confirming a diagnosis of myoglobin cast nephropathy. The patient was given IV steroids and underwent seven sessions of hemodialysis, following which there was complete recovery of renal function.
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Affiliation(s)
- Nishika Madireddy
- Department of Pathology, Apollo Hospitals Jubilee Hills, Hyderabad, Telangana, India
| | - Meenakshi Swain
- Department of Pathology, Apollo Hospitals Jubilee Hills, Hyderabad, Telangana, India
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31
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Tuan JJ, Ogbuagu O, Kumar D, Altice F, Fikrig M. Acute kidney injury due to myoglobin cast nephropathy in the setting of coronavirus disease 2019-mediated rhabdomyolysis: a case report. J Med Case Rep 2022; 16:491. [PMID: 36578087 PMCID: PMC9795945 DOI: 10.1186/s13256-022-03721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 12/09/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We present this case of coronavirus disease 2019-associated acute kidney injury with rhabdomyolysis-with noteworthy renal biopsy findings demonstrating myoglobin cast nephropathy-to add to the limited literature on coronavirus disease 2019-related acute kidney injury and rhabdomyolysis. CASE PRESENTATION A 67-year-old Caucasian man presented to our hospital with 3 weeks of malaise and decreased oral intake and several days of abnormal taste, poor appetite, decrease urine output, gastrointestinal symptoms, and myalgias, and was ultimately diagnosed with coronavirus disease 2019. His hospital course was complicated by acute kidney injury and, upon workup of his renal failure, was diagnosed with myoglobin cast nephropathy due to coronavirus disease 2019-mediated rhabdomyolysis. Ultimately, his renal function improved following hydration back to his baseline 6 weeks after his initial diagnosis of coronavirus disease 2019. CONCLUSIONS Given our limited knowledge of manifestations of coronavirus disease 2019, it is important to have a more in-depth understanding of the spectrum of disease of coronavirus disease 2019, which can affect various organ systems, including the kidney, and the manifestations of end-organ damage associated with it. We present this case to highlight a rarely reported finding of myoglobin cast nephropathy due to coronavirus disease 2019-mediated rhabdomyolysis.
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Affiliation(s)
- Jessica J Tuan
- Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar Street, PO Box 208022, New Haven, CT, 06510, USA.
- Yale AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
| | - Onyema Ogbuagu
- Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar Street, PO Box 208022, New Haven, CT, 06510, USA
- Yale AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA
| | - Deepika Kumar
- Department of Pathology and Laboratory Medicine, Yale University School of Medicine, 333 Cedar Street, PO Box 208022, New Haven, CT, 06510, USA
| | - Frederick Altice
- Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar Street, PO Box 208022, New Haven, CT, 06510, USA
| | - Margaret Fikrig
- Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar Street, PO Box 208022, New Haven, CT, 06510, USA
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32
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Dorleijn M, Smulders Y. [A man with cola-coloured urine]. Ned Tijdschr Geneeskd 2022; 166:D6862. [PMID: 36300479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A 37-year-old man was referred to the Emergency Department of the FundashonMariadal hospital in Bonaire because of an abnormal color of urine after having exercised heavily. Laboratory tests showed rhabdomyolysis with a creatine kinase level of 112.114 U/L. After hyperhydration creatine kinase values decreased rapidly, renal function remained normal.
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Affiliation(s)
- Mees Dorleijn
- FundashonMariadal, afd. Interne Geneeskunde, Kralendijk, Caribisch Nederland
- Contact: Mees Dorleijn
| | - Yvo Smulders
- FundashonMariadal, afd. Interne Geneeskunde, Kralendijk, Caribisch Nederland
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33
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Kuok CI, Chan WKY. Motor Vehicle Collision and Acute Kidney Injury in Children. Pediatr Emerg Care 2022; 38:545-549. [PMID: 35916728 DOI: 10.1097/pec.0000000000002677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our study aimed to determine the prevalence of acute kidney injury (AKI) in pediatric patients who sustained trauma due to motor vehicle collision (MVC) and identify factors associated with its development. METHODS We retrospectively reviewed the clinical information and laboratory tests of pediatric patients who were admitted because of MVC from January 2014 to April 2021. The occurrence of AKI was our primary outcome, which was defined by the Kidney Disease Improving Global Outcomes criteria. A serum creatine kinase (CK) level of 1000 IU/L or greater was defined as rhabdomyolysis. RESULTS Sixty-four patients (median age, 9.6 years) were included in the study. Twenty three of the patients (35.9%) developed AKI: stage 1 AKI in 18 (78.3%) and stage 2 AKI in 5 (21.7%) patients. Acute kidney injury patients had higher injury severity scores (no AKI: 5.0; stage 1 AKI: 10.5; stage 2 AKI: 26.0). Rhabdomyolysis was present in 21.1% of the patients and was associated with the overall AKI risk (odds ratio [OR], 7.3; 95% confidence interval [CI], 1.6-32.6) and stage 2 AKI (OR, 15.0; 95% CI, 1.4-163.2). Blood tests from AKI patients showed lower serum bicarbonate and base excess, higher leukocyte and CK levels on admission, and a higher peak CK in the first 72 hours of admission. Intubation in emergency department (OR, 11.1; 95% CI, 1.2-102.1) and surgical interventions (OR, 3.2; 95% CI, 1.0-9.8) were associated with AKI. Acute kidney injury patients required longer stay in pediatric intensive care unit (median 1.0 vs 2.3 days, P < 0.001) and hospital (median 4.1 vs 7.0 days, P = 0.010). CONCLUSIONS Approximately one third of pediatric patients who sustained trauma from MVC developed AKI. Initial blood results, including higher CK and leukocyte count, and lower bicarbonate and base excess, were associated with the development of AKI. Rhabdomyolysis occurred in approximately one fifth of the patients and was significantly associated with AKI.
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34
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Torr L, Mortimore G. The management and diagnosis of rhabdomyolysis-induced acute kidney injury: a case study. Br J Nurs 2022; 31:844-852. [PMID: 36094035 DOI: 10.12968/bjon.2022.31.16.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Rhabdomyolysis is characterised by a rapid dissolution of damaged or injured skeletal muscle that can be the result of a multitude of mechanisms. It can range in severity from mild to severe, leading to multi-organ failure and death. Rhabdomyolysis causes muscular cellular breakdown, which can cause fatal electrolyte imbalances and metabolic acidosis, as myoglobin, creatine phosphokinase, lactate dehydrogenase and other electrolytes move into the circulation; acute kidney injury can follow as a severe complication. This article reflects on the case of a person who was diagnosed with rhabdomyolysis and acute kidney injury after a fall at home. Understanding the underpinning mechanism of rhabdomyolysis and the associated severity of symptoms may improve early diagnosis and treatment initiation.
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Affiliation(s)
- Leah Torr
- Acute Kidney Injury Specialist Nurse, Royal Derby Hospital, University Hospitals of Derby and Burton Foundation Trust, Derby
| | - Gerri Mortimore
- Associate Professor in Advanced Clinical Practice, University of Derby, Derby
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35
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Min MK, Lee D, Shon SW, Ryu JH, Wang I, Lee MJ, Chun M, Hyun T. Russula subnigricans Poisoning Causes Severe Rhabdomyolysis That Could be Misdiagnosed as Non-ST Segment Elevation Myocardial Infarction. Wilderness Environ Med 2022; 33:324-328. [PMID: 35589501 DOI: 10.1016/j.wem.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 11/21/2022]
Abstract
Mushroom poisoning and subsequently the number of patients visiting emergency rooms are increasing, as well as the proportion of fatal mushroom poisonings. Myocytic mushroom poisoning is one of the new clinical classifications. This report documents the course of a family with Russula subnigricans poisoning complicated by severe rhabdomyolysis, including a case that was misdiagnosed as myocardial infarction. A 64-y-old man visited our hospital with symptoms including substernal chest discomfort, nausea, vomiting, and myalgia, lasting for 12 h. His laboratory tests showed elevated serum high-sensitive troponin I. He was diagnosed with non-ST segment elevation myocardial infarction. After that, 2 family members who ate mushrooms together were transferred from a local emergency room with the diagnosis of rhabdomyolysis. Consequently, rhabdomyolysis due to mushroom poisoning was diagnosed. They were hospitalized in the intensive care unit. After admission, conservative management, including primary fluid resuscitation, was performed, and the patients were discharged without complications. R subnigricans poisoning was revealed after investigation and should be considered in mushroom poisoning with rhabdomyolysis. Early recognition and intensive supportive care are important for mushroom poisoning patients.
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Affiliation(s)
- Mun Ki Min
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Daesup Lee
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
| | - Seung Woo Shon
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji Ho Ryu
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Iljae Wang
- Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea
| | - Min Jee Lee
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Mose Chun
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Taegyu Hyun
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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36
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Abstract
Pfizer-BioNTech COVID-19 (BNT162b2) conferred a high level of protection against Covid-19 with a proven short-term safety profile. Although cases of vaccine-associated myopericarditis have been reported, the existence of rhabdomyolysis without myocarditis has not yet been published. A 16-year-old, healthy male patient, who did not use any herbal or illegal drugs before, was admitted with muscle pain that developed after the second dose of BNT162b2 vaccine. Cardiac examination and heart enzymes were normal and the patient had significantly higher creatinine kinase levels. The patient, whose enzymes returned to normal with only force hydration therapy, recovered without complications. Reporting the side effects of the vaccine, which has a short history of application to large populations, is of vital importance in the conduct of vaccine development studies and in identifying the risky group in terms of side effects.
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Affiliation(s)
- Murat Sutcu
- Istinye University Faculty of Medicine, Bahcesehir Liv Hospital, Pediatric Infectious Diseases, Istanbul, Turkey
| | - Doruk Gul
- Istinye University Faculty of Medicine, Bahcesehir Liv Hospital, Pediatric, Istanbul, Turkey
| | - Fatih Atik
- Istinye University Faculty of Medicine, Bahcesehir Liv Hospital, Pediatric Cardiology, Istanbul, Turkey
| | - Manolya Kara
- Istinye University Faculty of Medicine, Ulus Liv Hospital, Pediatric Infectious Diseases, Istanbul, Turkey
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37
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Blais A. Succinylcholine, malignant hyperthermia and rhabdomyolysis. CMAJ 2022; 194:E878. [PMID: 35760427 PMCID: PMC9332916 DOI: 10.1503/cmaj.146480-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Alex Blais
- Anesthesiologist and Clinical Instructor, North Island Hospital Comox Valley; Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC
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38
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Anderson JL, Cole M, Pannell D. Management of Severe Crush Injuries in Austere Environments: A Special Operations Perspective. J Spec Oper Med 2022; 22:43-47. [PMID: 35639893 DOI: 10.55460/2y7a-igk7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
Crush injuries present a challenging case for medical providers and require knowledge and skill to manage the subsequent damage to multiple organ systems. In an austere environment, in which resources are limited and evacuation time is extensive, a medic must be prepared to identify trends and predict outcomes based on the mechanism of injury and patient presentation. These injuries occur in a variety of environments from motor vehicle accidents (at home or abroad) to natural disasters and building collapses. Crush injury can lead to compartment syndrome, traumatic rhabdomyolysis, arrythmias, and metabolic acidosis, especially for patients with extended treatment and extrication times. While crush syndrome occurs due to the systemic effects of the injury, the onset can be as early as 1 hour postinjury. With a comprehensive understanding of the pathophysiology, diagnosis, management, and tactical considerations, a prehospital provider can optimize patient outcomes and be prepared with the tools they have on hand for the progression of crush injury into crush syndrome.
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39
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Daniele D, Murray J. Update: Exertional rhabdomyolysis, active component, U.S. Armed Forces, 2017-2021. MSMR 2022; 29:15-20. [PMID: 35608521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Among active component service members in 2021, there were 513 incident cases of exertional rhabdomyolysis, for an unadjusted incidence rate of 38.6 cases per 100,000 person-years (p-yrs). Subgroup-specific rates in 2021 were highest among males, those less than 20 years old, non-Hispanic Black service members, Marine Corps or Army members, recruits, and those in “other” and combat-specific occupations. During 2017–2021, crude rates of exertional rhabdomyolysis reached a peak of 43.1 per 100,000 p-yrs in 2018 after which the rate decreased to 38.4 and 38.6 per 100,000 p-yrs in 2020 and 2021, respectively. Compared to those in other race/ethnicity groups, non-Hispanic Black service members had the highest overall rate of exertional rhabdomyolysis in every year of the period. Overall and annual rates were highest among Marine Corps members, intermediate among those in the Army, and lowest among those in the Air Force and Navy. Most cases of exertional rhabdomyolysis were diagnosed at installations that support basic combat/recruit training or major ground combat units of the Army or the Marine Corps. Medical care providers should consider exertional rhabdomyolysis in the differential diagnosis when service members (particularly recruits) present with muscular pain or swelling, limited range of motion, or the excretion of darkened urine after strenuous physical activity, especially in hot, humid weather.
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40
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Kamura Y, Terao T, Akao S, Kono Y, Honma K, Matsue K. Fatal thrombotic microangiopathy with rhabdomyolysis as an initial symptom after the first dose of mRNA-1273 vaccine: A case report. Int J Infect Dis 2022; 117:322-325. [PMID: 35189339 PMCID: PMC8853962 DOI: 10.1016/j.ijid.2022.02.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/18/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
We report a case of a Japanese man with severe rhabdomyolysis and multiple thrombosis of arterioles after the first dose of mRNA-1273 vaccine. He developed rapidly progressive rhabdomyolysis and infarctions of multiple organs. Antiplatelet factor 4 antibody test was negative. Despite the intensive supportive care, including aggressive fluid administration, hemodialysis, administration of anticoagulants, high-dose steroid, and eculizumab, the patient ultimately died of multiple organ failure. Autopsy revealed multiple thrombosis in the arterioles and organ necrosis. Low serum complements and C3 deposition in the renal glomeruli detected by immunofluorescence suggested a possible immune-mediated mechanism. To our knowledge, this is the first case report of rhabdomyolysis and multiple thrombosis of the arterioles as an adverse event following COVID-19 vaccination.
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Affiliation(s)
- Yuya Kamura
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, 929 Higashi-cho, Kamogawa-shi, Chiba, 296-8602, Japan
| | - Toshiki Terao
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, 929 Higashi-cho, Kamogawa-shi, Chiba, 296-8602, Japan
| | - Satoshi Akao
- Division of Rheumatology, Department of Internal Medicine, Kameda Medical Centre
| | - Yumi Kono
- Department of Intensive Care Medicine, Kameda Medical Centre
| | | | - Kosei Matsue
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, 929 Higashi-cho, Kamogawa-shi, Chiba, 296-8602, Japan.
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Cirillo E, Esposito C, Giardino G, Azan G, Fecarotta S, Pittaluga S, Ruggiero L, Barretta F, Frisso G, Notarangelo LD, Pignata C. Case Report: Severe Rhabdomyolysis and Multiorgan Failure After ChAdOx1 nCoV-19 Vaccination. Front Immunol 2022; 13:845496. [PMID: 35371100 PMCID: PMC8968726 DOI: 10.3389/fimmu.2022.845496] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/28/2022] [Indexed: 12/18/2022] Open
Abstract
Background Severe skeletal muscle damage has been recently reported in patients with SARS-CoV-2 infection and as a rare vaccination complication. Case summary On Apr 28, 2021 a 68-year-old man who was previously healthy presented with an extremely severe rhabdomyolysis that occurred nine days following the first dose of SARS-CoV-2 ChAdOx1 nCov-19 vaccination. He had no risk factors, and denied any further assumption of drugs except for fermented red rice, and berberine supplement. The clinical scenario was complicated by a multi organ failure involving bone marrow, liver, lung, and kidney. For the rapid increase of the inflammatory markers, a cytokine storm was suspected and multi-target biologic immunosuppressive therapy was started, consisting of steroids, anakinra, and eculizumab, which was initially successful resulting in close to normal values of creatine phosphokinase after 17 days of treatment. Unfortunately, 48 days after the vaccination an accelerated phase of deterioration, characterized by severe multi-lineage cytopenia, untreatable hypotensive shock, hypoglycemia, and dramatic increase of procalcitonin (PCT), led to patient death. Conclusion Physicians should be aware that severe and fatal rhabdomyolysis may occur after SARS-CoV2 vaccine administration.
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Affiliation(s)
- Emilia Cirillo
- Departments of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy
| | - Ciro Esposito
- Department of Transplants, A. Cardarelli Hospital, Naples, Italy
| | - Giuliana Giardino
- Departments of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy
| | - Gaetano Azan
- Department of Transplants, A. Cardarelli Hospital, Naples, Italy
| | - Simona Fecarotta
- Departments of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy
| | - Stefania Pittaluga
- Laboratory of Pathology Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Lucia Ruggiero
- Department of Neuroscience, Reproductive and Odontostomatological Science, Federico II University of Naples, Naples, Italy
| | - Ferdinando Barretta
- Department of Molecular Medicine and Medical Biotechnology , Federico II University of Naples, Naples, Italy
| | - Giulia Frisso
- Department of Molecular Medicine and Medical Biotechnology , Federico II University of Naples, Naples, Italy
| | - Luigi Daniele Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Claudio Pignata
- Departments of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy
- *Correspondence: Claudio Pignata,
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42
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Ahmed A, de Buitleir C, Elsheik N, Sweeney M. Very Long-Chain Acyl-CoA Dehydrogenase Deficiency Presenting as Rhabdomyolysis. Ir Med J 2022; 115:565. [PMID: 35532898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Presentation A 20 year old female attended the Emergency Department by ambulance following a collapse at a concert. On arrival she was complaining of generalised muscular pain. She had not eaten for over 12 hours and had been dancing for approximately 6 hours. The patient was known to have Very-long-chain acyl-CoA dehydrogenase deficiency (VLCAD). She had a normal exam, and normal vital signs. Diagnosis A diagnosis of rhabdomyolysis was made after her creatinine kinase (CK) was found to be >100000 units/litre (Normal range < 170U/L). Her urine was dark brown with urinalysis positive for blood. Treatment The patient was admitted to the high dependency unit, where she was treated with intravenous fluids. Her urine output and renal function were closely monitored. She made a full recovery and was discharged home four days later. Conclusion (VLCAD) is an inherited, autosomal recessive, metabolic disorder caused by mutations in the ACADVL gene. Management includes treatment of manifestation, primary prevention of manifestation, and prevention of secondary complications.
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Affiliation(s)
- A Ahmed
- Emergency Department, Sligo university Hospital, Sligo, Ireland
| | - C de Buitleir
- Emergency Department, Sligo university Hospital, Sligo, Ireland
| | - N Elsheik
- Emergency Department, Sligo university Hospital, Sligo, Ireland
| | - M Sweeney
- Emergency Department, Sligo university Hospital, Sligo, Ireland
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43
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Bernhardt I, Ryder B, Wilson C. Exertional rhabdomyolysis following return to exercise after COVID-19 lockdown. N Z Med J 2022; 135:117-119. [PMID: 35728147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Isaac Bernhardt
- Clinical Genetics and Metabolic Fellow, National Metabolic Service, Auckland City and Starship Children's Hospital
| | - Bryony Ryder
- Metabolic Consultant, National Metabolic Service, Auckland City and Starship Children's Hospital
| | - Callum Wilson
- Metabolic Consultant, National Metabolic Service, Auckland City and Starship Children's Hospital
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44
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Lewis RH, Perkins M, Fischer PE, Beebe MJ, Magnotti LJ. Timing is everything: Impact of combined long bone fracture and major arterial injury on outcomes. J Trauma Acute Care Surg 2022; 92:21-27. [PMID: 34670960 DOI: 10.1097/ta.0000000000003430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Timing of extremity fracture fixation in patients with an associated major vascular injury remains controversial. Some favor temporary fracture fixation before definitive vascular repair to limit potential graft complications. Others advocate immediate revascularization to minimize ischemic time. The purpose of this study was to evaluate the timing of fracture fixation on outcomes in patients with concomitant long bone fracture and major arterial injury. METHODS Patients with a combined long bone fracture and major arterial injury in the same extremity requiring operative repair over 11 years were identified and stratified by timing of fracture fixation. Vascular-related morbidity (rhabdomyolysis, acute kidney injury, graft failure, extremity amputation) and mortality were compared between patients who underwent fracture fixation prerevascularization (PRE) or postrevascularization (POST). RESULTS One hundred four patients were identified: 19 PRE and 85 POST. Both groups were similar with respect to age, sex, Injury Severity Score, admission base excess, 24-hour packed red blood cells, and concomitant venous injury. The PRE group had fewer penetrating injuries (32% vs. 60%, p = 0.024) and a longer time to revascularization (9.5 vs. 5.8 hours, p = 0.0002). Although there was no difference in mortality (0% vs. 2%, p > 0.99), there were more vascular-related complications in the PRE group (58% vs. 32%, p = 0.03): specifically, rhabdomyolysis (42% vs. 19%, p = 0.029), graft failure (26% vs. 8%, p = 0.026), and extremity amputation (37% vs. 13%, p = 0.013). Multivariable logistic regression identified fracture fixation PRE as the only independent predictor of graft failure (odds ratio, 3.98; 95% confidence interval, 1.11-14.33; p = 0.03) and extremity amputation (odds ratio, 3.924; 95% confidence interval, 1.272-12.111; p = 0.017). CONCLUSION Fracture fixation before revascularization contributes to increased vascular-related morbidity and was consistently identified as the only modifiable risk factor for both graft failure and extremity amputation in patients with a combined long bone fracture and major arterial injury. For these patients, delaying temporary or definitive fracture fixation until POST should be the preferred approach. LEVEL OF EVIDENCE Prognostic study, Level IV.
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Affiliation(s)
- Richard H Lewis
- From the Department of Surgery University of Tennessee Health Science Center, Memphis, Tennessee
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Dungan W, Young G, Collins B, Romano J, Honko N, Rockey D. Clostridioides difficile Induced Rhabdomyolysis Associated With Decompensated Cirrhosis. J Investig Med High Impact Case Rep 2022; 10:23247096221132249. [PMID: 36519690 PMCID: PMC9761200 DOI: 10.1177/23247096221132249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/06/2022] [Accepted: 09/25/2022] [Indexed: 12/23/2022] Open
Abstract
Rhabdomyolysis (RBD) occurs secondary to tissue injury, resulting in (muscle) cell lysis and release of intracellular electrolytes and proteins into circulation. An elevation in the muscle enzyme, creatine kinase (CK), is a diagnostic marker and indicates muscle breakdown. Symptoms include dark urine caused by release of myoglobin, myalgias, and acute kidney injury (AKI). RBD is categorized as (1) traumatic, (2) nontraumatic exertional (ie, metabolic myopathies), or (3) non-exertional and non-traumatic. Clostridioides difficile (CD) has been previously reported to cause RBD, but the risk factors, pathogenesis, and recommended treatment regimen remain unclear.
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Affiliation(s)
| | | | | | - John Romano
- Medical University of South Carolina,
Charleston, USA
| | | | - Don Rockey
- Medical University of South Carolina,
Charleston, USA
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Nakanishi T, Kenzaka T. Stiff-person syndrome with rhabdomyolysis. BMJ Case Rep 2021; 14:e246147. [PMID: 34906957 PMCID: PMC8671922 DOI: 10.1136/bcr-2021-246147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Toshiyuki Nakanishi
- Department of Internal Medicine, Nerima Hikarigaoka Hospital, Nerima-ku, Tokyo, Japan
| | - Tsuneaki Kenzaka
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Hyogo, Japan
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Abstract
ABSTRACT Exertional collapse associated with sickle trait (ECAST) is an underrecognized cause of exertional collapse triggered by complex mechanisms involving acidosis, rhabdomyolysis, and arrhythmias, all of which create sickling, vaso-occlusive problems, and ultimately end organ failure. Three cases are described in young athletes, as well as 12 other examples of ECAST noted in case reports and news sources. Exertional collapse associated with sickle trait can be differentiated from other common causes of collapse (exertional heat syndrome, acute cardiac events, and asthma) because it is a conscious collapse without neurological changes, occurs early in workout with only mildly elevated body temperature, and involves muscle pain and weakness but not cramping. Aggressive early management and transport to care facilities can reverse ECAST in certain cases. This article discusses tips for early recognition, initial treatment in the emergency department, and precautions that can be taken to prevent sickling collapse in athletes with sickle cell trait (SCT).
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Affiliation(s)
- Caroline Newman
- From the Department of Pediatrics, University of North Carolina Hospital System, Chapel Hill, NC
| | - Karl B Fields
- Cone Health Sports Medicine Fellowship Program, Cone Health Hospital System, Greensboro, NC
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Gooch C, Dean SJ, Marzullo L. Repeatedly in Rhabdomyolysis. Pediatr Emerg Care 2021; 37:e1759-e1760. [PMID: 32205805 DOI: 10.1097/pec.0000000000002079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Repeated presentations of a rare symptom in a patient should make a physician stop and evaluate for rare conditions. This is a report of a teenager with multiple episodes of rhabdomyolysis and weakness. He was eventually diagnosed as having McArdle muscular dystrophy, or glycogen storage disease type V. His rhabdomyolysis has been severe, with a creatinine kinase level of >320,000 U/L, myoglobinuria, transaminitis, and elevated bilirubin. He has a low threshold for triggering rhabdomyolysis, such as doing an hour of aerobic exercise 2 days in a row. McArdle disease is a glycogen storage disorder in which the skeletal muscle cannot convert glycogen to glucose. Unlike other glycogen storage disorders, McArdle muscular dystrophy only affects the skeletal muscle, sparing the brain and visceral organs, leading to a vague phenotype. These patients have exercise intolerance, muscle cramps, and rhabdomyolysis. Many patients report loading with simple carbohydrates before exercise, as they have learned that this can increase their stamina. The vague symptoms can lead to decades of delay in diagnosis and significant mismanagement. Rhabdomyolysis is the most dangerous sign of McArdle disease, and it can lead to acute kidney injury, resulting in renal failure requiring dialysis in the severest cases.Rhabdomyolysis has numerous causes, but when it is recurrent, especially with seemingly insignificant triggers, one needs to develop a broader differential and pursue advanced testing. This testing can include specific exercise tests, genetic sequencing, and muscle biopsy. This case report will guide the clinician through the process of evaluating recurrent rhabdomyolysis, working through the differential diagnosis and testing options.1.
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Affiliation(s)
| | | | - Laurie Marzullo
- Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL
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Abstract
Carnitine palmitoyltransferase II (CPT II) deficiency is a disorder affecting fatty acid oxidation. The myopathic form of the condition is the most common among adults and manifests itself with a high serum creatine kinase (CK) concentration. Triggers of very high CK concentrations include periods of fasting, infection, exercise, stress, and exposure to extreme temperatures. A 27-year-old man known to have CPT II deficiency presented feeling generally unwell after his COVID-19 vaccine. His CK concentration of 105,000 U/L and deranged liver function tests (ALT 300 U/L and AST 1496 U/L) were in keeping with rhabdomyolysis. His biochemical parameters and myopathy resolved with continuous intravenous dextrose 10% and a high carbohydrate diet. Caution should be exercised when administering vaccinations (including the COVID-19 vaccination) to this population. Clinicians should be wary for signs and symptoms of CPT II deficiency exacerbations and be vigilant in monitoring serum CK.
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Affiliation(s)
- Alicia Tan
- Warrington and Halton Hospitals NHS Trust, United Kingdom
- Email of the corresponding author:
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Lee IH, Cho S, Ahn DJ, Kim MK. Systemic lupus erythematosus presenting as hyponatremia-associated rhabdomyolysis: A case report. Medicine (Baltimore) 2021; 100:e27390. [PMID: 34596163 PMCID: PMC8483824 DOI: 10.1097/md.0000000000027390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Systemic lupus erythematosus (SLE) is an autoimmune disease that involves multiple organs and causes various clinical manifestations. Cases of rhabdomyolysis as the initial presentation of SLE are rare, and there are no reported cases of SLE presenting hyponatremia-associated rhabdomyolysis as the first manifestation. Herein, we report a case of SLE with lupus nephritis in a patient with acute hyponatremia-associated rhabdomyolysis. PATIENT CONCERNS A 44-year-old woman was admitted with complaints of altered consciousness, myalgia, and red-brownish urine that first appeared three days prior. Peripheral blood tests revealed elevated creatine kinase (19,013 IU/L) and myoglobin (5099 U/L) levels and severe hyponatremia (111 mEq/L) with no azotemia. Urinalysis showed nephritic sediments. DIAGNOSIS Whole-body bone scintigraphy showed increased uptake of radiotracer in the both upper and lower extremities. Serological evaluation revealed the presence of anti-nuclear (speckled pattern, 1:640), anti-double stranded DNA, and anti-Smith antibodies and absence of anti-Jo-1 antibody. A kidney biopsy demonstrated mesangial proliferative (class II) lupus nephritis. INTERVENTIONS Fluid therapy, including intravenous administration of 3% NaCl, was initiated. After three consecutive days of intravenous methylprednisolone (1 g/d), oral prednisolone (1 mg/kg/d), mycophenolate mofetil, and hydroxychloroquine were administered. OUTCOMES On day 28, the patient was discharged with marked resolution of SLE-associated symptoms and laboratory findings. Lupus reactivation was not present during the subsequent six-month follow-up. LESSONS Hyponatremia-associated rhabdomyolysis can be the first manifestation of SLE. Moreover, prompt fluid therapy and timely administration of immunosuppressive agents in SLE patients presenting with hyponatremia and rhabdomyolysis can significantly help alleviate disease activity and improve clinical outcomes.
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Affiliation(s)
- In Hee Lee
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Seong Cho
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Dong Jik Ahn
- Department of Internal Medicine, HANSUNG Union Internal Medicine Clinic and Dialysis Center, Daegu, Republic of Korea
| | - Min-Kyung Kim
- Department of Pathology, Dongguk University College of Medicine, Gyeongju, Republic of Korea
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