Inflammatory myopathy and severe rhabdomyolysis induced by leuprolide acetate therapy for prostate cancer: a case report

Michael Bergner,Martin Rohacek,Paul Erne

doi:10.1186/1752-1947-5-409

Michael Bergner, Martin Rohacek + Show 1 more

Open Access

https://doi.org/10.1186/1752-1947-5-409

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Abstract

IntroductionLeuprolide acetate is a synthetic analog of gonadotropin-releasing hormone used for the treatment of prostate cancer. Its side effects are hot flashes, nausea, and fatigue. We report a case of a patient with proximal inflammatory myopathy accompanied by severe rhabdomyolysis and renal failure following the second application of leuprolide acetate. Drug withdrawal and steroid therapy resulted in remission within six weeks of the diagnosis. To the best of our knowledge, our case report describes the second case of leuprolide acetate-induced inflammatory myopathy and the first case of severe leuprolide acetate-induced rhabdomyolysis and renal failure in the literature.Case presentationA 64-year-old Swiss Caucasian man was admitted to the hospital because of progressive proximal muscle weakness, dyspnea, and oliguria. He had been treated twice with leuprolide acetate in monthly doses. We performed a muscle biopsy, which excluded other causes of myopathy. The patient's renal failure and rhabdomyolysis were treated with rehydration and steroid therapy.ConclusionThe aim of our case report is to highlight the rare but severe side effects associated with leuprolide acetate therapy used to treat patients with inflammatory myopathy: severe rhabdomyolysis and renal failure.

Highlights

Leuprolide acetate is a synthetic analog of gonadotropin-releasing hormone used for the treatment of prostate cancer
The aim of our case report is to highlight the rare but severe side effects associated with leuprolide acetate therapy used to treat patients with inflammatory myopathy: severe rhabdomyolysis and renal failure
In the course of searching for a possible inflammatory myopathy, we found no clinical or serological signs of endocrinopathies, viral infections, or connective tissue diseases and no immunohistochemical signs of autoimmune polymyositis or dermatomyositis

Summary

Introduction

The etiology of myopathy includes congenital disorders, immunologic processes, malignancies, infections, endocrinopathies, alcohol ingestion and adverse drug reactions ( statins), immunosuppressive agents, and nucleoside analog reverse transcriptase inhibitors [1,2,3,4,5]. His laboratory values were as follows: hemoglobin 148 g/L, leukocyte count 14.7 × 109/L, erythrocyte sedimentation rate 14 mm/ hour, creatine kinase 121,530 U/L, C-reactive protein 39 mg/L, creatinine 51 μmol/L, BUN 6.4 mmol/L, sodium 122 mmol/L, and potassium 4.3 mmol/L His serum 25OH vitamin D level and thyroid gland function were normal, and his human immunodeficiency virus test was negative. The patient was discharged from the hospital free of symptoms after undergoing orchiectomy on the 45th day following his initial admission His serum creatine kinase and serum creatinine were normal, and he was prescribed prednisone 50 mg/day. Nine months after discharge his prednisone therapy was stopped without a subsequent increase in his creatine kinase level At his 12-month follow-up examination, the patient was in good clinical condition and had normal laboratory values, including PSA

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