Late-onset rhabdomyolysis in pneumococcal meningitis: a case report

Five factors contributing to severe rhabdomyolysis in a 21 yr old IV drug abuser: a case report

Rhabdomyolysis is a potentially life-threatening condition resulting from the release of large quantities of myocyte breakdown products into the circulation, following injury to striated muscles. There are several causes of rhabdomyolysis - traumatic and non-traumatic. We present a 21-year-old male intravenous drug abuser, who was referred to us with fever, altered sensorium and seizures. He developed severe rhabdomyolysis following a mixed meningeal infection by Streptococcus pneumoniae and Mycobacterium tuberculosis. This patient’s examination and investigation suggested a combination of factors leading to the severe rhabdomyolysis which proved fatal. The patient’s creatine phosphokinase was elevated to 167,000 U/L, following hyperpyrexia, seizures, meningitis (pneumococcal and tuberculous), pentazocine and alcohol abuse. The increase in mortality rate with the onset of rhabdomyolysis warrants immediate cessation of the insult and aggressive management.

Listeria monocytogenes meningitis associated with rhabdomyolysis and acute renal failure

INTRODUCTION

Numerous systemic infections are capable of inducing myositis and rhabdomyolysis. Clinical course of the disease is in the great majority of patients benign and without development of renal dysfunction. However, serious consequences are possible if acute renal failure (ARF) occurs, especially in critically ill patients.

METHODS

Patient with Listeria monocytogenes meningitis associated with rhabdomyolysis and acute non-oliguric ARF is presented.

RESULTS

Sixty-nine-year-old white male was admitted to our intensive care unit because of listerial meningitis. The course of the disease was complicated with rhabdomyolysis and non-oliguric ARF. After antimicrobial treatment with parenteral trimethoprim-sulfamethoxazole and 4 days of continuous veno-venous hemodiafiltration (CVVHDF) the patient recovered.

CONCLUSION

We report a case of listerial meningitis complicated with non-oliguric ARF. Rhabdomyolysis should be considered in all patients with infection and increased CK, especially if consciousness is impaired is altered. Furthermore, despite the normal diuresis ARF could be present and result in adverse consequences. We infer that timely diagnosis and treatment should improve the outcome of infection-induced rhabdomyolysis and could prevent a proportion of associated ARF.