Rhabdomyolysis: Heroin induced or HCV related

Abstract

Abstract Rhabdomyolysis is defined as dissolution of skeletal muscle, manifested by the release of myocyte contents into the circulation. It is a well recognized complication of toxins, recreational drugs, and medications. We report a case of a 32 year old man, intravenous heroin abuser who took heroin 2 days before presentation. He presented with oliguria, tea colored urine and painful bilateral lower limb swelling. Evaluation revealed azotemia, dyselectrolytemia (hyperkalemia and hyponatremia), proteinuria and hematuria. Highly elevated serum lactate dehydrogenase and creatinine kinase led to the diagnosis of rhabdomyolysis and acute renal failure. The patient was managed with hydration and haemodialysis, following which he improved appreciably. Rhabdomyolysis in heroin addicts is caused by muscle ischemia, direct myotoxic effects of heroin, skeletal muscle vasoconstriction and immunologic reaction. The patient was also found to have concurrent hepatitis C virus infection (HCV). HCV is known to produce extrahepatic manifestations like myositis. Some studies have proved isolation of HCV RNA from perivascular infiltrative lymphocytes and skeletal muscle fibers, implying that HCV may decrease the threshold for muscle lysis. This case highlights the probable role of HCV in predisposing rhabdomyolysis in an illicit drug abuser, which has not been reported in Indian literature.