Rhabdomyolysis complicated with acute renal failure induced by levofloxacin

Abstract

A 74-year-old male patient with urinary tract infection received an intravenous infusion of levofloxacin 0.3 g twice daily. On day 4, the patient developed muscular soreness in bilateral crus. The next day, the patient's symptom of muscle pain became worse accompanied by waist and back pain and the urine was brown with decreased urine volume. Laboratory tests revealed the following results: alanine aminotransferase (ALT) 1 487 U/L, aspartate aminotransferase (AST) 106 U/L, γ-glutamine transferase (γ-GT) 94 U/L, total bilirubin (TBil) 37.4 μmol/L, direct bilirubin 25.2 (DBil) μmol/L, creatine kinase (CK) 1 446 U/L, lactate dehydrogenase (LDH) 414 U/L, alpha-hydroxybutyric dehydrogenase (α-HBDH) 464 mmol/L, creatine kinase isoenzyme (CK-MB) 34 U/L, serum creatinine 397 μmol/L, blood urea nitrogen (BUN) 28 mmol/L, uric acid (UA) 823 mmol/L, carbon dioxide combining power (CO2CP) 17 mmol/L, urine occult blood (+ + + ), urine protein(+ + + ), microscopic examination of white blood cell 3-5/HP. The patient was considered to have rhabdomyolysis with acute renal failure induced by levofloxacin. Levofloxacin was withdrawn, and he received the supplement of fluid, alkalinization of urine, diuretic and liver protection therapy. Two days later, the patient's urine volume increased. One week later, the muscle pain disappeared. Eight days later, laboratory tests revealed the following results: ALT 48 U/L, AST 39 U/L, γ-GT 60 U/L, TBil 19.6 μmol/L, DBil 11.5 μmol/L, CK186 U/L, LDH 235 U/L, α-HBDH 160 mmol/L, CK-MB 22 U/L, SCr 98 μmol/L, BUN 7.8 mmol/L, UA 397 mmol/L, CO2CP21 mmol/L. Key words: Ofloxacin; Rhabdomyolysis; Acute kidney injury