Rhabdomyolysis developing after transcatheter arterial chemoembolization for hepatocellular carcinoma

Polymyositis and rhabdomyolysis caused by hepatocellular carcinoma - Case report and literature review

Introduction

Rhabdomyolysis is a syndrome characterized by a rapid necrosis of muscle fibers and the release of muscle-derived metabolic products into the circulatory system. A rare cause of rhabdomyolysis is paraneoplastic polymyositis.

Case presentation

A 67-year-old man was diagnosed with paraneoplastic polymyositis and rhabdomyolysis caused by hepatocellular carcinoma (HCC). Intravenous steroid was used as a symptomatic therapy for rhabdomyolysis, and the tumour was removed by left hemihepatectomy to treat the underlying cause. After muscle strength gradually improved, steroid therapy was discontinued. The patient was reoperated multiple times due to bleeding and bile leakage. Following the operations, his overall state and muscle strength further improved. Despite that, the patient's condition worsened again, and eventually, he died of candida albicans pneumonia and sepsis.

Discussion

HCC is an extremely rare cause of paraneoplastic polymyositis and rhabdomyolysis. Treatment is challenging, as none of the few available case reports record long term survival and less than half of the reports record muscle strength improvement. In our case, the patient was treated with systemic steroid therapy and resection of the tumour. The patient's muscle strength temporarily improved, but subsequently, the patient died.

Conclusion

Our case confirms the importance of a definitive treatment of HCC, as we achieved a significant improvement in muscle strength by removing the tumour. On the other hand, our paper highlights the dangers of double-sided steroid therapy, which, combined with the essential, effective treatment of rhabdomyolysis, may have contributed to the development of postoperative complications and candida sepsis leading to death.

Ipsilateral Deltoid and Hand Compartment Syndrome: A Case Report and Review of the Literature

CASE

We present the unique case of deltoid and hand compartment syndrome in a young man after prolonged syncope because of polysubstance use. The patient was subsequently treated with urgent deltoid and hand compartment fasciotomies which resulted in full recovery of his shoulder function.

CONCLUSIONS

Patients suspected of deltoid compartment syndrome should have a thorough physical examination, followed by repeat examinations. Invasive compartment monitoring should be used in equivocal cases, in patients with decreased level of consciousness, and in patients with distracting injury. Once diagnosed, deltoid compartment syndrome (± other compartments) should be taken for emergent fasciotomy, ensuring adequate decompression of all 3 deltoid compartments.