Case Of Rhabdomyolysis Research Articles

S3734 A Case of Terbinafine-Associated DILI and Rhabdomyolysis That Progressed to Liver and Acute Renal Failure

S3734 A Case of Terbinafine-Associated DILI and Rhabdomyolysis That Progressed to Liver and Acute Renal Failure

S3846 A Case of Statin-Associated Rhabdomyolysis and Acute Liver Injury

S3846 A Case of Statin-Associated Rhabdomyolysis and Acute Liver Injury

Pain management and clinical considerations of a rare case of rhabdomyolysis caused by a hyperextension position after open radical cystectomy

Pain management and clinical considerations of a rare case of rhabdomyolysis caused by a hyperextension position after open radical cystectomy

Compartment Syndrome Caused by a Hyperextension Position after Open Radical Cystectomy with Hautmann Ileal Neobladder Construction: A Rare Case of Rhabdomyolysis

Compartment syndrome (CS) is caused by an excessive increase in compartment intramuscular pressure, which measurement is the reference diagnostic tool. We examine the case of a 44yearold man with invasive bladder cancer who underwent an open radical cystectomy. After extubation, the patient is transferred from the operating room to the Intermediate Care Unit, where he complains of severe lumbar pain on a visual analog scale of 10 that is unresponsive to opioids and is diagnosed with rhabdomyolysis due to compartment syndrome. Multidisciplinary care and multimodal analgesia approaches were used; no fasciotomy was performed; and a favourable outcome was achieved.

Fatal rhabdomyolysis caused by COVID-19 infection: a case report.

The authors presented a 48-year-old female with fatal rhabdomyolysis caused by COVID-19 infection. She was referred to us with cough, generalized myalgia and arthralgia, and fever during the last week. Laboratory results showed an elevated erythrocyte sedimentation rate, elevated C-reactive protein level, and elevated creatine kinase. The nasopharyngeal swab confirmed the diagnosis of coronavirus 2 RNA infection. She was managed initially in the COVID-19 isolation department. Three days later, she was transferred to the intensive care unit and mechanically ventilated. Laboratory results were consistent with rhabdomyolysis. She died because of cardiac arrest due to continuous hemodynamic deterioration. Rhabdomyolysis is a serious condition that can be fatal or cause disability. Rhabdomyolysis cases have been reported in COVID-19 patients. Rhabdomyolysis cases have been reported in COV19 patients. Further studies are needed to understand the mechanism and to optimize the treatment.

A multicenter, open-label, single-arm phase 1/2 study to evaluate the safety and efficacy of FCN-159 in pediatric participants with neurofibromatosis type 1.

10023 Background: Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disease characterized by multiple progressive tumor and non-tumor manifestations, with abnormal activating MAPK pathway. Plexiform neurofibromas (PN) presents in 20-50% of NF1 patients (pts) and may cause serious complications. Selumetinib was approved for pediatric pts with NF1-related PN in US and EU, but therapeutic options remain limited in China. FCN-159 is a highly potent selective anti-tumorigenic inhibitor of MEK1/2, potentially effective in NF1-related PN. Methods: This multi-center, open-label phase1/2 clinical trial is the first-in human study to assess safety and efficacy in pediatric pts with NF1-related PN. The primary objective was to determine the dose limiting toxicity (DLT) and recommended phase 2 dose (RP2D) in the dose escalation, followed by a dose expansion phase 2 to evaluate safety and efficacy. The starting dose in pediatric pts was determined according to the adults in the dose-escalation phase (previously published in ASCO 2022, abstract no. 3011). Here, we first present the safety and efficacy results in pediatric participants. Results: As of data cut-off (November 21, 2022), 65 pts were enrolled, 19 pts in phase 1 and 45 pts in phase 2. A dose of 4 mg/m2 (10 pts) and 5 mg/m2 (9 pts) were evaluated in phase 1 and no DLT was observed. Pediatric pts in the 5 mg/m2 cohort achieved similar exposure to the 8 mg adult cohort. AUC simulation from population PK model at different BSA ranges were also similar to the adults of 8 mg. Therefore, the RP2D was determined to be 5 mg/m2.Treatment-emergent adverse events (TEAEs) were reported in 62 pts (95.4%). Common TEAEs (≥ 20%) were mouth ulcer (43.1%), sinus arrhythmia (36.9%), upper respiratory tract infection (35.4%), folliculitis (21.5%), paronychia (21.5%), and increased blood creatine phosphokinase (20%). 5 pts (7.7%) experienced grade ≥3 treatment-related AEs (TRAEs), including 2 pts (2/10, 10%) in the 4 mg/m2 group and 3 pts (3/55, 5.5%) in the 5 mg/m2 group. Grade 3 TRAEs were increased aspartate aminotransferase (1.5%), electrocardiogram QT prolongation (1.5%), folliculitis (3.1%), and dermatitis acneiform (1.5%). No grade ≥ 4 TRAEs were observed. 2 pts (3.1%) reported treatment-related serious adverse events (one case of rhabdomyolysis and dermatitis acneiform each). TEAEs led to dose interruption (26.2%), and discontinuation (1.5%). No reported TEAE led to dose reduction or death. Of the 19 pts with at least one tumor assessment data after baseline, 8 (42%) pts had partial response, 11 (57.8%) with stable disease and none with disease progression. The median DOR could not be evaluated. Conclusions: Overall, FCN-159 was well-tolerated and demonstrated promising anti-tumor activity in pediatric participants with NF1-related PN. Long-term efficacy and safety follow-up are ongoing. Clinical trial information: NCT04954001 .

Developing In Vitro Models to Define the Role of Direct Mitochondrial Toxicity in Frequently Reported Drug-Induced Rhabdomyolysis.

The United States Food and Drug Administration Adverse Event Reporting System (FAERS) logged 27,140 rhabdomyolysis cases from 2004 to 31 March 2020. We used FAERS to identify 14 drugs frequently reported in 6583 rhabdomyolysis cases and to investigate whether mitochondrial toxicity is a common pathway of drug-induced rhabdomyolysis by these drugs. Preliminary screening for mitochondrial toxicity was performed using the acute metabolic switch assay, which is adapted here for use in murine L6 cells. Fenofibrate, risperidone, pregabalin, propofol, and simvastatin lactone drugs were identified as mitotoxic and underwent further investigation, using real-time respirometry (Seahorse Technology) to provide more detail on the mechanism of mitochondrial-induced toxicity. To confirm the human relevance of the findings, fenofibrate and risperidone were evaluated in primary human skeletal muscle-derived cells (HSKMDC), using the acute metabolic switch assay and real-time respirometry, which confirmed this designation, although the toxic effects on the mitochondria were more pronounced in HSKMDC. Overall, these studies demonstrate that the L6 model of acute modification may find utility as an initial, cost-effective screen for identifying potential myotoxicants with relevance to humans and, importantly, that drug-induced mitochondrial dysfunction may be a common mechanism shared by some drugs that induce myotoxicity.

Rhabdomyolysis following Oxford/AstraZeneca COVID-19 vaccination; two case reports from Iran

Defined as the destruction of the skeletal muscle wall and the release of cellular contents into the bloodstream, rhabdomyolysis has been reported as a complication for some forms of vaccines. On the other hand, the COVID-19 pandemic has led to the extensive production and use of several vaccines against SARS-CoV-2, meanwhile, the side effects of these vaccines are gradually being reported. Up to now, few cases of rhabdomyolysis due to COVID-19 vaccination have been reported in the studies. The present study intended to report two cases of rhabdomyolysis due to vaccination with Oxford/AstraZeneca COVID-19 vaccines. The patients were two men aged 70 and 75 years old who presented to a healthcare facility with weakness, myalgia, nausea, and vomiting for about ten days after receiving their first dose of the Oxford/AstraZeneca COVID-19 vaccine. Patients had elevated levels of creatine phosphokinase (CPK), which were 5540 IU/L and 18760 IU/L in patients, respectively.

A Case of Rhabdomyolysis with Rigors

Please view the PDF to see the formatted meeting abstract.

Abstract #1408127: A Case of Rhabdomyolysis Resulting in Fulminant Acute Kidney Injury in a Patient with Severe Hypothyroidism

Rhabdomyolysis is characterized by muscle necrosis and the release of intracellular muscle contents into circulation. Hypothyroidism is known to be associated with musculoskeletal problems, rarely rhabdomyolysis. We report a case of severe hypothyroidism due to a prior thyroidectomy with poor medication adherence, who presented with rhabdomyolysis resulting in severe acute kidney injury requiring urgent dialysis. A 65-year-old male with a past medical history of papillary thyroid cancer status post total thyroidectomy presented with lethargy, confusion, decreased oral intake and decreased urination. He recently ran out of levothyroxine. Notably, the patient had also been taking rosuvastatin. On examination, the patient was afebrile, with a pulse of 70 bpm and blood pressure of 111/70 mmHg. He was oriented to self and place but not to time. He demonstrated slow deep voice along with macroglossia and trace non-pitting lower extremity edema. There were no signs of proximal myopathy or neurological deficits. Workup was remarkable for TSH >90.00 mcU/mL, free T4 < 0.1 ng/dl, CPK 22,030 mcg/L, AST 233 U/L, ALT 205 U/L, creatinine 31.6 mg/dl, and BUN 124 mg/dl. The last known TSH was 4.5, free T4 was 1 ng/dL, and creatinine was 0.9 in January 2021. The urine specimen was positive for loaded red blood cells. Renal ultrasound showed no obstruction. Diagnosis of rhabdomyolysis with acute renal failure was made and he was promptly started on dialysis. Endocrinology was consulted and he was started on intravenous levothyroxine. A renal biopsy confirmed acute tubular necrosis due to rhabdomyolysis. After several days, his symptoms improved, and he was transitioned to oral levothyroxine however he remained on dialysis on discharge. Hypothyroid myopathy is most often limited to myalgia, cramps, and sometimes mildly elevated levels of muscle enzymes. Rhabdomyolysis can rarely develop due to severe hypothyroidism. Muscle breakdown in hypothyroidism is caused by poor contractility, low myosin ATPase activity, and low ATP turnover in the skeletal muscles. These metabolic abnormalities may sensitize patients with hypothyroidism to develop rhabdomyolysis. Acute renal failure, as a result of an accumulation of myoglobin in renal tubules, is the most life-threatening complication of rhabdomyolysis and can develop in up to 33% of patients. There have been very few case reports of hypothyroidism causing rhabdomyolysis, with a precipitating factor such as exercise, trauma, or drugs such as statin. Our patient presented with severe hypothyroidism complicated by rhabdomyolysis resulting in acute renal failure requiring dialysis. The patient was also on a statin which may cause statin-induced rhabdomyolysis due to hypothyroidism. This case emphasizes the importance of adherence to levothyroxine in hypothyroid patients as well as the importance of considering rhabdomyolysis in patients with severe hypothyroidism as a cause of acute renal failure. It also shows the importance of reviewing the patient's medication list and discontinuing all those medications which can escalate the process of rhabdomyolysis in a patient with hypothyroidism.

Rhabdomyolysis with Co-Administration of Statins and Antiplatelet Therapies-Analysis of the WHO Pharmacovigilance Database.

While statins and antiplatelet therapies are largely prescribed together worldwide, limited information is available on the safety of their association regarding rhabdomyolysis occurrence. We aimed to assess the reporting of rhabdomyolysis in patients treated with a combination of statin and antiplatelet therapy, compared to statin alone. We used the World Health Organization pharmacovigilance database (VigiBase®) to compare the rhabdomyolysis reporting between statin (atorvastatin, fluvastatin, pravastatin, rosuvastatin, and simvastatin) plus antiplatelet therapy (acetylsalicylic acid, clopidogrel, prasugrel and ticagrelor) groups versus statin alone groups, for each statin and antiplatelet therapy. Study setting was restricted to patients aged 45 or older, including reports up until 1st September, 2021. We computed reporting Odds-Ratio (ROR) and their 95% confidence interval (CI) to quantify the disproportionality between groups, adjusted on age and sex. Among the 11,431,708 reports of adverse reactions, we extracted 9,489 cases of rhabdomyolysis in patients treated with statins, of whom 2,464 (26%) were also treated with antiplatelet therapy. The reporting of rhabdomyolysis was increased when ticagrelor was associated with atorvastatin (ROR 1.30 [1.02-1.65]) or rosuvastatin (ROR 1.90 [1.42-2.54]) compared to the respective statin alone but did not change when aspirin, clopidogrel or prasugrel were considered. Rhabdomyolysis reporting was increased when ticagrelor -but not other antiplatelet agents- was notified with the most prescribed statins in practice. This finding needs to be considered by physicians especially in high-risk patients.

Rhabdomyolysis caused by interaction between rosuvastatin and vadadustat: a case report

BackgroundRhabdomyolysis is a potentially life-threatening disease caused by melting or necrosis of skeletal muscle cells and leakage of muscle components into the bloodstream. It has been reported that the interaction of the HMG-CoA reductase inhibitor rosuvastatin with the renal anemia drug vadadustat increases the blood concentration of rosuvastatin in vitro. In this study, we report a case of suspected rhabdomyolysis caused by the drug interaction of rosuvastatin and vadadustat in clinical practice.Case presentationA 62-year-old male with medical records of hypertension, myocardial infarction, chronic renal failure, renal anemia, dyslipidemia, and alcoholic liver disease. The patient had been diagnosed with chronic kidney disease (CKD) at the Department of Nephrology, and treated by outpatient care with renal support therapy for the past two years. On X-63 day, his prescription was rosuvastatin (10 mg/day) and a continuous erythrocyte-stimulating agent, epoetin beta pegol (genetical recombination, 100 μg). X-Day 0, blood tests revealed creatine phosphokinase (CPK) 298 U/L, serum creatinine (SCr) 5.26 mg/dL, and hemoglobin (Hb) 9.5 g/dL; thus, the prescription was changed from epoetin beta pegol 100 μg to vadadustat 300 mg/day. On X + day 80, a prescription for a diuretic (azosemide 15 mg/day) was added for swelling of the lower extremities. On X + day 105, we found CPK 16,509 U/L, SCr 6.51 mg/dL, and Hb 9.5 g/dL. The patient was diagnosed as rhabdomyolysis and hospitalized. After hospitalization, rosuvastatin and vadadustat were discontinued and we administered intravenous fluids. Thereafter, CPK and SCr values of the patient improved. On X + day 122, CPK improved to 29 U/L, SCr to 2.6 mg/dL, and Hb to 9.6 g/dL, and he was discharged on X + day 124. At discharge, rosuvastatin 2.5 mg/day was resumed. A blood test on X + day 133 showed CPK 144 U/L and SCr 4.2 mg/dL.ConclusionWe experienced a case of rhabdomyolysis caused by drug interactions between rosuvastatin and vadadustat.

Rhabdomyolysis Caused by a Behavioral Manifestation of Acute Mania

AbstractIntroductionWhile seen in patients with bipolar disorder due to NMS, antipsychotic side effects, or substance use, rhabdomyolysis resulting from behaviors seen in mania has not been reported in recent literature. We present a case of a patient with rhabdomyolysis due to exertion during a manic episode.CaseA 29-year-old male with a history of bipolar disorder type 1 was brought to the ED in June 2022 after he was found on the roof of a local theater sharing excerpts from a book he had written. Temperatures outside were 100–102 Fahrenheit. On presentation, the patient had rapid, pressured speech and demonstrated flight of ideas. He was religiously preoccupied. He had been previously admitted to Psychiatric Emergency Services in April 2022 for mania and was discharged with lithium and lamotrigine. He had been titrating these medications with his outpatient psychiatrist.The patient’s labs showed an elevated creatinine of 1.49, up from his baseline of 1.09. Further workup revealed an elevated CK of 3,538. Additional abnormalities included an AST of 70, calcium of 10.6, total bilirubin of 1.6, and WBC of 15.5. He was afebrile, oriented, and had no obvious signs of infection. The patient received 2 liters of Lactated Ringers (LR) and was admitted to Internal Medicine. Later, he was agitated overnight and received 10mg olanzapine and 2mg lorazepam. Lithium level following fluid resuscitation was 0.6.On interview the next day, the patient described working on a creative religious piece that he wanted to share with others, leading to him climbing on the roof. He had been hyper-focused on this work, with 1–4 hours of sleep nightly. He also had been frequently doing gymnastics, walking long distances, and climbing other buildings. He endorsed diffuse muscle pain, but this was not reproducible on exam.150mL/hr of LR was started, and PO fluid intake was encouraged. He agreed to resume his medications and was started on lithium 900mg and lamotrigine 50mg. His CK continued to downtrend. WBC count decreased and was 12.9 at discharge. Lamotrigine was titrated up to home dose of 100mg. His mania improved, and he was ultimately discharged home with outpatient follow-up.ConclusionRhabdomyolysis results from the release of toxic cellular compounds from muscle fibers. Complications include acute renal failure, hyperkalemia, and compartment syndrome. Causes include substance use, medications, trauma, seizures, ischemia, overexertion, and dehydration. Recently reported cases of mania-associated rhabdomyolysis involve iatrogenic causes, such as neuromuscular malignant syndrome (NMS) and non-NMS antipsychotic side effects.Other causes include high-risk drug use during mania. Rhabdomyolysis due to behavioral manifestations of mania have been documented more rarely in older reports, similarly, addressing excessive exercise and dehydration. Therefore, our case represents a reminder of the medical sequalae resulting from actions undertaken during acute mania. This highlights the importance of implementing effective treatment to prevent such episodes.FundingNo Funding

A Case of Levetiracetam-induced Rhabdomyolysis

A Case of Levetiracetam-induced Rhabdomyolysis

485 - A case of rhabdomyolysis following a crossfit session in a young healthy male athlete

485 - A case of rhabdomyolysis following a crossfit session in a young healthy male athlete

Rhabdomyolysis in a pregnant woman: A case report

Hyperemesis gravidarum may prompt hypovolemia and significant electrolyte anomalies. Hypokalemia is one of the most common abnormalities. When practical, it may lead to rhabdomyolysis. We report a rare case of rhabdomyolysis in a 24 years old pregnant woman due to hyperemesis gravidarum. She had a profound weakness. Physical examination and laboratory findings showed a need for the hospital admission. Aggressive rehydration and electrolytes were the definite treatment. Her serum creatinine kinase (CK) concentration during entry was 80,01 units/L. Continuous rehydration led to complete recovery clinically. On discharge, she had normal laboratories.

Ritodrine-induced rhabdomyolysis and psychiatric symptoms: a case report and literature review

BackgroundRitodrine hydrochloride, a β2-adrenergic agonist, has been widely used in Asia and Europe to treat preterm labor in pregnant women. It has some typical side effects, such as palpitations, pulmonary edema, and hypokalemia. Here, we report a case of rhabdomyolysis and psychiatric symptoms might be associated with intravenous ritodrine.Case presentationA 32-year-old Chinese primigravida woman who was pregnant with twins by in vitro fertilization-embryo transfer was diagnosed with placenta previa and threatened abortion at 21 gestational weeks (GW). The patient was then treated with ritodrine hydrochloride. The initial dose of ritodrine was 150 μg/min, gradually increasing to 360 μg/min at 235/7 GW and 400 μg/min at 271/7 GW. Magnesium sulfate was added to the ritodrine regimen at 215/7 GW in dosage of 1-2 g/h. Psychiatric symptoms appeared at 245/7, 265/7, and 273/7 GW, manifesting as depression, anxiety, and suicidal tendencies. Severe muscle pain in her limbs and general weakness appeared after six weeks of ritodrine administration, which might have been a sign of rhabdomyolysis resulting from ritodrine administration. After ceasing the administration of ritodrine, the muscle pain and relevant data from laboratory tests on the patient were significantly improved, and her mood was stable. It is worth noting that this is the first time to report psychiatric symptoms may associated with the administration of ritodrine. In addition, we reviewed and analyzed six reported cases of rhabdomyolysis caused by ritodrine.ConclusionOur results suggest that we should pay more attention to the risk of rhabdomyolysis and psychiatric symptoms induced by intravenous ritodrine hydrochloride, especially in patients with a history of neuromuscular disorder, or concomitant use of magnesium sulfate.

Exertional rhabdomyolysis in a fallow deer (Cervus dama)

The aim of this report was to present a case of exertional rhabdomyolysis in a fallow deer. The diagnosis was made on the basis of clinical and blood laboratory findings. Despite the treatment, the outcome was fatal. Gross anatomy and histopathological examinations were performed, detecting degenerative changes in the heart, skeletal muscles, the kidneys and the liver. On the basis of ante and post mortem findings providing explanations of the pathophysiological mechanism of severe tissue damage - hypoxaemia, severe lactic acidosis, muscle rupture, electrolyte imbalance and renal block, it was concluded that all they have led to the death of the animal.

Рабдомиолиз при COVID-19

The infectious process in a number of its complications has rhabdomyolysis, which can be the cause of acute kidney injury. In our analysis, rhabdomyolysis was detected in 0.31% of cases. The most severe course was observed with COVID-19. The purpose of the study is to describe a clinical case of severe rhabdomyolysis in a patient with COVID-19. It is necessary to remain vigilant in the treatment of patients with infectious pathology, in the event of asthenia, muscle pain, it is necessary to conduct an additional examination with the determination of myoglobin, creatine phosphokinase, additional methods (ultrasound, radionuclide diagnostic method). Key words: COVID-19, rhabdomyolysis, mixed infections

Rosuvastatin-Induced Reversible Rhabdomyolysis

We report a case of rhabdomyolysis (RM) in a postpercutaneous transluminal coronary angioplasty patient caused by a high dose of rosuvastatin. She was admitted to the hospital with complaints of muscle weakness, myalgia, and passing red-colored urine for the last 7 days. Routine blood investigations showed serum creatinine 1.51 mg/dl, creatinine phosphokinase (CPK) 31,000 U/L, and urine myoglobin 934 ng/ml. The patient was diagnosed with rosuvastatin-induced RM. Rosuvastatin was stopped on the day of admission, and intravenous fluids were started with strict monitoring of clinical and biochemical profile. Consequently, her CPK and urine myoglobin started decreasing and her symptoms improved. The patient was discharged from the hospital on the 10th day without a statin. Rosuvastatin-induced RM is discussed as a potentially preventable life-threatening side effect.