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Mertsoy Y, Kavak S, Yildirim MS, Kacar E, Kaya S, Gunay E. Rhabdomyolysis in patients with COVID-19: A cause or consequence of acute kidney injury or mortality? Medicine (Baltimore) 2025; 104:e42368. [PMID: 40324245 PMCID: PMC12055050 DOI: 10.1097/md.0000000000042368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 04/17/2025] [Accepted: 04/20/2025] [Indexed: 05/07/2025] Open
Abstract
Rhabdomyolysis can occur due to many traumatic and nontraumatic causes. Rhabdomyolysis has been reported in new type of coronavirus disease (COVID-19) cases. The aim of our study was to examine the effects of rhabdomyolysis on mortality and renal outcomes in patients hospitalized in our hospital's COVID-19 wards. In our single-center and retrospective study, we included patients who were admitted with a diagnosis of COVID-19 by a thorax-computed tomography finding who were older than 18 years of age and with a measured creatinine kinase (CK) > 1000 U/L on any day of hospitalization. The same number of patients hospitalized in COVID-19 services with CK < 1000 U/L and with similar gender and age were determined as the control group. We analyzed the data of 2065 patients, and compared 154 patients in the rhabdomyolysis group (group 1) and 154 patients in the control group (group 2). Acute kidney injury (AKI) (44.2% vs 21.4%; P < .001), intensive care unit (ICU) admissions (53.2% vs 13.6%; P < .001), intubation (75.6% vs 23.8%; P < .001), mortality (36.4% vs 3.2%; P < .001) and the need for dialysis (3.9% vs 0.6%; P = .005) were seen more in the rhabdomyolysis group. When that group was divided into the early rhabdomyolysis group (group 1a), where the CK value reached its highest value in ≤3 days, and the late rhabdomyolysis group (group 1b), where it was ≥ 4 days, AKI (29.7% vs 65.1%; P < .001), ICU (35.2% vs 79.4%; P < .001), intubation (56.2% vs 88%; P = .001), mortality (18% vs 61.9%; P < .001), and dialysis (1.1% vs 7.9%; P = .031), the results were higher in the group 1b. The available data suggest that rhabdomyolysis seen in COVID-19 patients is not a direct predictor of mortality and poor renal outcomes, but is a secondary outcome to multiple-organ failure caused by worsening clinical status.
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Affiliation(s)
- Yilmaz Mertsoy
- Department of Orthopedics and Traumatology, University of Health Sciences, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Seyhmus Kavak
- Department of Radiology, University of Health Sciences, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Mehmet Serdar Yildirim
- Department of Internal Medicine, University of Health Sciences, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Emrah Kacar
- Department of Internal Medicine, University of Health Sciences, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Sehmuz Kaya
- Department of Orthopedics and Traumatology, Van Yuzuncu Yil University, Dursun Odabas Medical Center, Van, Turkey
| | - Emrah Gunay
- Department of Nephrology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
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Noh D, Cha YH. Veno-venous extracorporeal membrane oxygenation application for patient with acute lung injury due to rhabdomyolysis; a case report. Trauma Case Rep 2025; 57:101154. [PMID: 40166418 PMCID: PMC11957526 DOI: 10.1016/j.tcr.2025.101154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2025] [Indexed: 04/02/2025] Open
Abstract
A 47-year-old male patient, who underwent open reduction and internal fixation with plate for a Gustilo-Anderson type II open proximal tibiofibular fracture of the right lower leg, experienced rhabdomyolysis. Rapid progression of acute respiratory distress syndrome and acute renal failure occurred due to rhabdomyolysis. After veno-venous extracorporeal membrane oxygenation, he exhibited a relatively smooth clinical recovery. Our case report suggests that circulating cytotoxic substances from rhabdomyolysis resulted in concomitant acute respiratory distress syndrome and acute renal failure. This case was successfully treated after applying extracorporeal membrane oxygenation.
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Affiliation(s)
- Dongsub Noh
- Department of Thoracic and Cardiovacular Surgery, Dankook University, Cheonan, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Yong Han Cha
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
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Welcome FS, Elizaire TCM, Airola MV. Lipin phosphatidic acid phosphatases: Structure, function, regulation, and disease association. Adv Biol Regul 2025; 96:101082. [PMID: 39948013 DOI: 10.1016/j.jbior.2025.101082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Accepted: 02/02/2025] [Indexed: 05/31/2025]
Abstract
Lipids play essential roles as structural barriers in cell membranes, long-term energy storage, and as signaling molecules. One class of enzymes involved in lipid synthesis are lipins. Lipins are magnesium-dependent phosphatidic acid phosphatases that produce diacylglycerol, playing key roles in TAG synthesis, de novo phospholipid synthesis and metabolism. Here, we review recent advances on the structure, function, and regulation of lipins with a particular focus on the structural impacts of missense mutations associated with rhabdomyolysis, Majeed syndrome and neuropathies. Structural insights reveal that while some disease-associated mutations directly disrupt catalysis, many missense mutations are not near the active site, but still play a key role in PAP activity. With the resolved crystal structure of a lipin homolog Tt Pah2, AlphaFold, and AlphaMissense it has become increasingly possible to predict the pathogenicity and structural contributions of individual residues and mutations. Going forward, this structural information can be used to predict and understand new mutations as they arise.
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Affiliation(s)
- Franceine S Welcome
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Taisha C M Elizaire
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Michael V Airola
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, NY, 11794, USA.
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Uctepe E, Mancılar H, Esen FN, Unverengil GG, Vona B, Yesilyurt A. A Homozygous MYH1 Variant Underlies Autosomal Recessive Isolated Recurrent Rhabdomyolysis. Am J Med Genet A 2025; 197:e63952. [PMID: 39687948 DOI: 10.1002/ajmg.a.63952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Revised: 10/21/2024] [Accepted: 11/16/2024] [Indexed: 12/18/2024]
Abstract
Rhabdomyolysis is a severe condition involving the breakdown of skeletal muscle fibers, leading to the release of muscle components into the bloodstream, which can lead to potential complications such as acute kidney injury and electrolyte imbalances. The etiology of rhabdomyolysis is multifactorial, encompassing traumatic, exertional, metabolic, infectious, toxic, and genetic causes. Genetic causes, including variants in LPIN1, RYR1, and CACNA1S, are increasingly recognized as significant contributors to recurrent rhabdomyolysis. MYH1 has recently been identified as a candidate gene for recurrent rhabdomyolysis with limited evidence originating from a single patient. In this report, we describe a 35-year-old male, born to consanguineous parents, who presented with recurrent rhabdomyolysis attacks, beginning at age 28, characterized by muscle pain, weakness, and episodes of acute kidney injury requiring dialysis. During attacks, the patient exhibited remarkably elevated markers of muscle breakdown and mildly elevated creatine kinase levels between episodes. A muscle biopsy revealed non-specific myopathic changes. Exome sequencing analysis was carried out and revealed a novel homozygous variant (NM_005963.4: c.1825G>A [p.Val609Met]) in MYH1 segregating in a manner compatible with an autosomal recessive pattern. In summary, this case provides confirmatory support for the role of pathogenic MYH1 variants in the pathogenesis of recurrent rhabdomyolysis and emphasizes the importance of comprehensive genetic testing in patients with unexplained recurrent episodes of muscle breakdown. Further cases are necessary to fully elucidate the genotypic and phenotypic spectrum of MYH1-related muscle disorders.
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Affiliation(s)
- Eyyup Uctepe
- Acibadem Labgen Genetic Diagnosis Center, Istanbul, Türkiye
| | | | | | | | - Barbara Vona
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
- Institute for Auditory Neuroscience and InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
| | - Ahmet Yesilyurt
- Acibadem Labgen Genetic Diagnosis Center, Istanbul, Türkiye
- Acibadem Maslak Hospital, Istanbul, Türkiye
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Kruijt N, Laforet P, Vissing J, Bhai S, Stemmerik MG, Kleefeld F, Voermans NC. 276th ENMC workshop: recommendations on optimal diagnostic pathway and management strategy for patients with acute rhabdomyolysis worldwide. 15th-17th March 2024, Hoofddorp, The Netherlands. Neuromuscul Disord 2025; 50:105344. [PMID: 40220353 DOI: 10.1016/j.nmd.2025.105344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2025] [Accepted: 03/17/2025] [Indexed: 04/14/2025]
Abstract
The 276th ENMC Workshop on rhabdomyolysis brought together 21 experts to address the compelling need for standardized guidelines on the clinical approach of rhabdomyolysis. There was a general agreement that a diagnosis of rhabdomyolysis require that 1) clinical symptoms include severe muscle swelling, weakness and/or myalgia; 2) serum CK-levels exceed 10,000 IU/L in case of exertional, and >5000 IU/L in non-exertional rhabdomyolysis; 3) CK-levels reaching a maximum 1-4 days after the event and normalizing to baseline within 1-2 weeks of rest. In case of an underlying neuromuscular condition, CK-levels should exceed 5-10 times the patient's baseline level. Treatment should be initiated only in case of high risk on acute kidney injury, which can be predicted by the McMahon score. Furthermore, recommendations on performing genetic testing were formulated and the use of the 'RHABDO'- acronym was generally agreed upon as a tool to aid clinicians in deciding which patients require genetic testing. Moreover, recommendations on follow-up were made, with a particular emphasis on evaluation of physical and psychological sequelae. Patient representatives present during the workshop emphasized the importance of the current recommendations for future clinical guidelines on rhabdomyolysis.
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Affiliation(s)
- Nick Kruijt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pascal Laforet
- Neurology Department, Raymond Poincaré Hospital, AP-HP, Nord-Est-Île-de-France Neuromuscular Reference Center, Garches, France
| | - John Vissing
- Copenhagen Neuromuscular Center, 8077, Department of Neurology, University of Copenhagen, Rigshospitalet, Denmark
| | - Salman Bhai
- University of Texas Southwestern Medical Center, Dallas, TX, USA; Neuromuscular Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas, TX, USA
| | - Mads Godtfeldt Stemmerik
- Copenhagen Neuromuscular Center, 8077, Department of Neurology, University of Copenhagen, Rigshospitalet, Denmark
| | - Felix Kleefeld
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Neurology, Charitéplatz 1, 10117, Berlin, Germany
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Ohara N, Tani T, Terajima K, Ozawa T, Yoneoka Y, Shimada H, Nakamura Y, Hasegawa G, Nishiyama T. Primary Aldosteronism and Hypokalemia-induced Rhabdomyolysis in a Patient with Aldosterone-producing Adenoma: A Case Report and Literature Review. Intern Med 2025; 64:871-879. [PMID: 39135257 PMCID: PMC11986306 DOI: 10.2169/internalmedicine.3629-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/27/2024] [Indexed: 03/18/2025] Open
Abstract
Many cases of primary aldosteronism (PA) in patients who developed hypokalemia-induced rhabdomyolysis and underwent adrenalectomy for aldosterone-producing adenoma (APA) have been reported; however, the immunohistopathological and molecular features remain unknown. We herein report the case of a 28-year-old woman with PA who presented with hypokalemia-induced rhabdomyolysis and underwent adrenalectomy for unilateral APA. An immunohistochemical analysis revealed that most adenoma cells were positive for steroidogenic enzymes, including CYP11B2. A genetic analysis revealed a somatic mutation in the KCNJ5. These findings suggest a strong aldosterone production capacity in our patient's adenoma, which was presumably related to her severe hyperaldosteronism and the resultant hypokalemia-induced rhabdomyolysis.
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Affiliation(s)
- Nobumasa Ohara
- Department of Endocrinology and Metabolism, Uonuma Kikan Hospital, Japan
| | - Takashi Tani
- Department of Neurology, Uonuma Kikan Hospital, Japan
| | | | | | | | - Hiroki Shimada
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Yasuhiro Nakamura
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Go Hasegawa
- Department of Pathology, Uonuma Kikan Hospital, Japan
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Aminifard T, Mehri S, Khajavirad A, Moosavi Z, Hosseinian S, Hosseinzadeh H. Trans-sodium crocetinate attenuates acute kidney injury induced by rhabdomyolysis in rats: focusing on PI3K/AKT, apoptosis, and autophagy pathways. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2025:10.1007/s00210-025-03910-9. [PMID: 40080154 DOI: 10.1007/s00210-025-03910-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Accepted: 02/10/2025] [Indexed: 03/15/2025]
Abstract
Rhabdomyolysis (RM) is a clinical disorder characterized by the release of potentially toxic muscle cell components into the bloodstream, with acute kidney injury (AKI). Trans-sodium crocetinate (TSC) is derived from the carotenoid crocetin known for its renoprotective, anti-inflammatory, and antioxidant properties. This study aimed to assess the protective effects of TSC on RM-induced AKI in rats. Six groups of rats (n = 6) were used: control, AKI (50% glycerol 10 mL/kg, intramuscularly), AKI treated with TSC (10, 20, and 40 mg/kg, intraperitoneally), and TSC (40 mg/kg) alone groups. Two days after the initial injection, urine and blood samples were collected over 24 h to investigate creatine phosphokinase (CPK), kidney function markers, and electrolyte levels. Additionally, kidney tissue was collected to assess renal oxidative markers, histological alterations, and the expression of protein markers related to autophagy, apoptosis, renal injury, inflammation, and the PI3K/AKT signaling pathway. After glycerol administration, there was an increase in oxidative stress, autophagy, apoptosis, renal injury, and inflammatory marker levels, accompanied by a decrease in the proteins of the PI3K/AKT signaling pathway in the kidney. The co-administration of TSC with glycerol resulted in the improvement of renal dysfunction and structural abnormalities, achieved through a reduction in oxidative stress. TSC also down-regulated autophagy, apoptotic, renal injury, and inflammatory markers. Furthermore, TSC treatment led to a decrease in the renal expression of PI3K/AKT signaling pathway proteins. In conclusion, TSC exhibited a protective effect against RM-induced AKI by modulating oxidative stress, autophagy, apoptosis, and the PI3K/AKT pathway.
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Affiliation(s)
- Tahereh Aminifard
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soghra Mehri
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Abolfazl Khajavirad
- Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Moosavi
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Sara Hosseinian
- Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Hosseinzadeh
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
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Kodama K, Imai T, Kuwana T, Ootsuka S, Kinoshita K. Two Cases of Levetiracetam-Induced Rhabdomyolysis With Low Levetiracetam Blood Concentrations. Cureus 2025; 17:e80877. [PMID: 40255845 PMCID: PMC12009161 DOI: 10.7759/cureus.80877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2025] [Indexed: 04/22/2025] Open
Abstract
Levetiracetam is an antiepileptic drug used to treat tonic-clonic convulsions and partial seizures. In general, levetiracetam is well tolerated; however, rhabdomyolysis has been reported as a rare side effect. The underlying mechanism is unclear. This case report describes two cases of rhabdomyolysis during levetiracetam treatment for convulsive status epilepticus, both of whom developed rhabdomyolysis a few days after starting levetiracetam. When levetiracetam was replaced with lacosamide, creatinine kinase decreased to the normal range within approximately 10 days. Furthermore, blood levels of levetiracetam were measured at the onset of rhabdomyolysis, and the results suggest that its adverse effects may not be correlated with its levels in the blood. Monitoring creatinine kinase is important for early detection of levetiracetam-induced rhabdomyolysis.
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Affiliation(s)
- Kentaro Kodama
- Department of Pharmacy, Nihon University Itabashi Hospital, Tokyo, JPN
| | - Toru Imai
- Department of Pharmacy, Nihon University Itabashi Hospital, Tokyo, JPN
| | - Tsukasa Kuwana
- Department of Acute Medicine, Nihon University School of Medicine, Tokyo, JPN
| | - Susumu Ootsuka
- Department of Pharmacy, Nihon University Itabashi Hospital, Tokyo, JPN
| | - Kosaku Kinoshita
- Department of Acute Medicine, Nihon University School of Medicine, Tokyo, JPN
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Lu YW, Wang JY, Hsu TJ, Chung WS. Risk of rhabdomyolysis in patients with mental disorders. Postgrad Med 2025; 137:201-208. [PMID: 39962880 DOI: 10.1080/00325481.2025.2466411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 02/06/2025] [Indexed: 02/20/2025]
Abstract
OBJECTIVES Rhabdomyolysis is caused by rapid muscle breakdown. Although patients with mental disorders are more susceptible to rhabdomyolysis, its incidence in this group is poorly established. Therefore, we conducted a population-based cohort study to investigate its incidence and risk in this group. METHODS We conducted a retrospective cohort study of 120,094 patients with mental disorders and 120,094 control patients from the Taiwan National Health Insurance Research Database. We excluded patients with rhabdomyolysis diagnosed before the index date, which was defined as the date of the first diagnosis of the mental disorder and beginning of antipsychotic medication. We matched the case cohort 1:1 with a control cohort by a propensity score method. RESULTS The overall incidence of rhabdomyolysis were 3.21 per 1000 person-years in the patients with mental disorders and 1.16 per 1000 person-years in the patients without mental disorders. After controlling for potential covariates, the patients with mental disorders showed an adjusted hazard ratio (aHR) of 2.77 (95% Cl: 2.62-2.92) compared with the controls. Men exhibited a risk of rhabdomyolysis 1.29-fold that exhibited by women (95% CI: 1.22-1.35). Alcoholic liver disease (aHR, 2.35) and generalized convulsive epilepsy (aHR, 2.06) were independent risk factors for rhabdomyolysis. Phenothiazines with aliphatic side-chains (aHR, 1.43), or piperidine structures (aHR, 1.54); butyrophenone derivatives (aHR, 1.24); lithium (aHR, 1.18) were independent risk factors for rhabdomyolysis after adjustment for covariates. CONCLUSIONS The risk of rhabdomyolysis is significantly higher for patients with mental disorders than that for patients without mental disorders.
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Affiliation(s)
- Ya-Wen Lu
- Pharmaceutical department, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Tzu-Ju Hsu
- Management Office for Health Data (DryLab), Clinical Trial Research Center (CTC), China Medical University Hospital, Taichung, Taiwan
| | - Wei-Sheng Chung
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
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Yang BF, Li D, Liu CL, Luo Y, Shi J, Guo XQ, Fan HJ, Lv Q. Advances in rhabdomyolysis: A review of pathogenesis, diagnosis, and treatment. Chin J Traumatol 2025:S1008-1275(25)00010-0. [PMID: 40082140 DOI: 10.1016/j.cjtee.2024.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 09/21/2024] [Accepted: 10/25/2024] [Indexed: 03/16/2025] Open
Abstract
Rhabdomyolysis (RM) is a multifactorial clinical syndrome characterized by the disintegration and necrosis of muscle tissue, leading to the release of cellular contents into the circulation. One of the most severe complications of RM is acute kidney injury, with a mortality rate of 20%-50%. Early and timely diagnosis is the key to improving the prognosis of patients with RM. The etiology of RM is complex and associated with various traumas, drugs, medications, and hereditary diseases, and the clinical symptoms are nonspecific. Therefore, its diagnosis highly relies on the doctor's experience and the level of medical equipment. However, RM often occurs in situations with limited medical resources, such as natural disasters, battlefields, and large-scale traffic accidents. In these scenarios, the varying levels of expertise among rescue personnel can lead to delays in diagnosis and treatment, thereby increasing the risk of mortality. This article provides a comprehensive review of the etiology, pathogenesis, complications, diagnostic, and treatment methods of RM. It also aims to offer new perspectives on the diagnosis and prognosis of RM by integrating machine learning and artificial intelligence. It is believed that this article can help pre-hospital rescuers and in-hospital doctors have a comprehensive understanding of RM to improve the patients' outcomes and overcome the challenges.
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Affiliation(s)
- Bo-Fan Yang
- School of Disaster and Emergency Medicine, Tianjin University, Tianjin, 300072, China
| | - Duo Li
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, 325000, Zhejiang Province, China
| | - Chun-Li Liu
- School of Disaster and Emergency Medicine, Tianjin University, Tianjin, 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, 325000, Zhejiang Province, China
| | - Yu Luo
- School of Disaster and Emergency Medicine, Tianjin University, Tianjin, 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, 325000, Zhejiang Province, China
| | - Jie Shi
- School of Disaster and Emergency Medicine, Tianjin University, Tianjin, 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, 325000, Zhejiang Province, China
| | - Xiao-Qin Guo
- School of Disaster and Emergency Medicine, Tianjin University, Tianjin, 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, 325000, Zhejiang Province, China
| | - Hao-Jun Fan
- School of Disaster and Emergency Medicine, Tianjin University, Tianjin, 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, 325000, Zhejiang Province, China
| | - Qi Lv
- School of Disaster and Emergency Medicine, Tianjin University, Tianjin, 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, 325000, Zhejiang Province, China.
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Xiong Y, Shi H, Wang J, Gu Q, Song Y, Kong W, Lyu J, Zhao M, Meng X. Predictive model for assessing the prognosis of rhabdomyolysis patients in the intensive care unit. Front Med (Lausanne) 2025; 11:1518129. [PMID: 39867923 PMCID: PMC11759279 DOI: 10.3389/fmed.2024.1518129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 12/16/2024] [Indexed: 01/28/2025] Open
Abstract
Background Rhabdomyolysis (RM) frequently gives rise to diverse complications, ultimately leading to an unfavorable prognosis for patients. Consequently, there is a pressing need for early prediction of survival rates among RM patients, yet reliable and effective predictive models are currently scarce. Methods All data utilized in this study were sourced from the MIMIC-IV database. A multivariable Cox regression analysis was conducted on the data, and the performance of the new model was evaluated based on the Harrell's concordance index (C-index) and the area under the receiver operating characteristic curve (AUC). Furthermore, the clinical utility of the predictive model was assessed through decision curve analysis (DCA). Results A total of 725 RM patients admitted to the intensive care unit (ICU) were included in the analysis, comprising 507 patients in the training cohort and 218 patients in the testing cohort. For the development of the predictive model, 37 variables were carefully selected. Multivariable Cox regression revealed that age, phosphate max, RR mean, and SOFA score were independent predictors of survival outcomes in RM patients. In the training cohort, the AUCs of the new model for predicting 28-day, 60-day, and 90-day survival rates were 0.818 (95% CI: 0.766-0.871), 0.810 (95% CI: 0.761-0.855), and 0.819 (95% CI: 0.773-0.864), respectively. In the validation cohort, the AUCs of the new model for predicting 28-day, 60-day, and 90-day survival rates were 0.840 (95% CI: 0.772-0.900), 0.842 (95% CI: 0.780-0.899), and 0.842 (95% CI: 0.779-0.897), respectively. Conclusion This study identified crucial demographic factors, vital signs, and laboratory parameters associated with RM patient prognosis and utilized them to develop a more accurate and convenient prognostic prediction model for assessing 28-day, 60-day, and 90-day survival rates. Implications for clinical practice This study specifically targets patients with RM admitted to ICU and presents a novel clinical prediction model that surpasses the conventional SOFA score. By integrating specific prognostic indicators tailored to RM, the model significantly enhances prediction accuracy, thereby enabling a more targeted and effective approach to managing RM patients.
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Affiliation(s)
- Yaxin Xiong
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hongyu Shi
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jianpeng Wang
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Quankuan Gu
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yu Song
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Weilan Kong
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Mingyan Zhao
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Heilongjiang Provincial Key Laboratory of Critical Care Medicine, Harbin, Heilongjiang, China
| | - Xianglin Meng
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Heilongjiang Provincial Key Laboratory of Critical Care Medicine, Harbin, Heilongjiang, China
- Department of Nuclear Medicine, Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China
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12
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de Calbiac H, Imbard A, de Lonlay P. Cellular mechanisms of acute rhabdomyolysis in inherited metabolic diseases. J Inherit Metab Dis 2025; 48:e12781. [PMID: 39135340 DOI: 10.1002/jimd.12781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 12/28/2024]
Abstract
Acute rhabdomyolysis (RM) constitutes a life-threatening emergency resulting from the (acute) breakdown of skeletal myofibers, characterized by a plasma creatine kinase (CK) level exceeding 1000 IU/L in response to a precipitating factor. Genetic predisposition, particularly inherited metabolic diseases, often underlie RM, contributing to recurrent episodes. Both sporadic and congenital forms of RM share common triggers. Considering the skeletal muscle's urgent need to rapidly adjust to environmental cues, sustaining sufficient energy levels and functional autophagy and mitophagy processes are vital for its preservation and response to stressors. Crucially, the composition of membrane lipids, along with lipid and calcium transport, and the availability of adenosine triphosphate (ATP), influence membrane biophysical properties, membrane curvature in skeletal muscle, calcium channel signaling regulation, and determine the characteristics of autophagic organelles. Consequently, a genetic defect involving ATP depletion, aberrant calcium release, abnormal lipid metabolism and/or lipid or calcium transport, and/or impaired anterograde trafficking may disrupt autophagy resulting in RM. The complex composition of lipid membranes also alters Toll-like receptor signaling and viral replication. In response, infections, recognized triggers of RM, stimulate increased levels of inflammatory cytokines, affecting skeletal muscle integrity, energy metabolism, and cellular trafficking, while elevated temperatures can reduce the activity of thermolabile enzymes. Overall, several mechanisms can account for RMs and may be associated in the same disease-causing RM.
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Affiliation(s)
- Hortense de Calbiac
- INSERM U1151, Institut Necker Enfants-Malades (INEM), Université Paris Cité, Paris, France
| | - Apolline Imbard
- Service de Biochimie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Faculté de pharmacie, LYPSIS, Université Paris Saclay, Orsay, France
- Reference Center for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, APHP, Imagine Institute, Filière G2M, MetabERN, Paris, France
| | - Pascale de Lonlay
- INSERM U1151, Institut Necker Enfants-Malades (INEM), Université Paris Cité, Paris, France
- Reference Center for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, APHP, Imagine Institute, Filière G2M, MetabERN, Paris, France
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13
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Albin CSW, Cunha CB, Glaser TP, Schachter M, Snow JW, Oto B. The Approach to Altered Mental Status in the Intensive Care Unit. Semin Neurol 2024; 44:634-651. [PMID: 39137901 DOI: 10.1055/s-0044-1788894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Altered mental status (AMS) is a syndrome posing substantial burden to patients in the intensive care unit (ICU) in both prevalence and intensity. Unfortunately, ICU patients are often diagnosed merely with syndromic labels, particularly the duo of toxic-metabolic encephalopathy (TME) and delirium. Before applying a nonspecific diagnostic label, every patient with AMS should be evaluated for specific, treatable diseases affecting the central nervous system. This review offers a structured approach to increase the probability of identifying specific causal etiologies of AMS in the critically ill. We provide tips for bedside assessment in the challenging ICU environment and review the role and yield of common neurodiagnostic procedures, including specialized bedside modalities of diagnostic utility in unstable patients. We briefly review two common etiologies of TME (uremic and septic encephalopathies), and then review a selection of high-yield toxicologic, neurologic, and infectious causes of AMS in the ICU, with an emphasis on those that require deliberate consideration as they elude routine screening. The final section lays out an approach to the various etiologies of AMS in the critically ill.
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Affiliation(s)
| | - Cheston B Cunha
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| | - Timlin P Glaser
- University of Arizona College of Medicine, Phoenix, Arizona
- Banner University Medical Center, Phoenix, Arizona
| | | | - Jerry W Snow
- University of Arizona College of Medicine, Phoenix, Arizona
- Banner University Medical Center, Phoenix, Arizona
| | - Brandon Oto
- sBridgeport Hospital, Yale New Haven Health, Bridgeport, Connecticut
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14
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Karimi M, Faal Hamedanchi N, Ansari K, Nahavandi R, Mazdak M, Javaherchian F, Koochaki P, Asadi Anar M, Shirforoush Sattari M, Mohamaditabar M. Rhabdomyolysis secondary to COVID-19 infection and vaccination: a review of literature. Front Med (Lausanne) 2024; 11:1460676. [PMID: 39635585 PMCID: PMC11614617 DOI: 10.3389/fmed.2024.1460676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 11/06/2024] [Indexed: 12/07/2024] Open
Abstract
Rhabdomyolysis (RML), characterized by the breakdown of skeletal muscle fibers and the release of muscle contents into the bloodstream, has emerged as a notable complication associated with Coronavirus disease 2019 (COVID-19) infection and vaccination. Studies have reported an increased incidence of RML in individuals with severe COVID-19 infection. However, the exact mechanisms remain unclear and are believed to involve the host's immune response to the virus. Furthermore, RML has been documented as a rare adverse event following COVID-19 vaccination, particularly with mRNA vaccines. Proposed mechanisms include immune responses triggered by the vaccine and T-cell activation against viral spike proteins. This study aims to review the current literature on the incidence, pathophysiology, clinical presentation, and outcomes of RML secondary to COVID-19 infection and vaccination. We identify common risk factors and mechanisms underlying this condition by analyzing case reports, clinical studies, and pharmacovigilance data. Our findings suggest that while RML is a relatively rare adverse event, it warrants attention due to its potential severity and the widespread prevalence of COVID-19 and its vaccines. This review underscores the need for heightened clinical awareness and further research to optimize management strategies and improve patient outcomes in this context.
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Affiliation(s)
- Mehdi Karimi
- Faculty of Medicine, Bogomolets National Medical University, Kyiv, Ukraine
| | - Neda Faal Hamedanchi
- Faculty of Medicine, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
| | - Kazem Ansari
- Nano-Biotech Foresight Company Biotechnology Campus, Yazd Stem Cells and Regenerative Medicine Institute, Yazd, Iran
| | - Reza Nahavandi
- Department of Biochemical and Pharmaceutical Engineering, School of Chemical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Mahsa Mazdak
- School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Fateme Javaherchian
- School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Pooneh Koochaki
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Mahsa Asadi Anar
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Nawaz MY, Hamdani R, Siddiqui MK, Patel N, Shah K, Langdon L. Rhabdomyolysis Without Acute Kidney Injury in a 14-Year-Old Child With a Sedentary Lifestyle. Cureus 2024; 16:e73381. [PMID: 39659318 PMCID: PMC11630056 DOI: 10.7759/cureus.73381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2024] [Indexed: 12/12/2024] Open
Abstract
A 14-year-old African American female patient presented to the emergency department with moderate right calf pain of unknown origin. The pain was present for a couple of days without radiation and progressed with an inability to bear weight. Physical examination revealed tenderness to palpation over the right calf. The patient had no history of overweight, trauma, infection, or extreme physical exertion. She took no medications, supplements, herbals, or used any illegal drugs. Of note, the patient was sedentary. Her blood work revealed elevated creatine kinase and liver enzymes, diagnostic of rhabdomyolysis. All other diagnostic evaluations, including EKG, chest X-ray, leg ultrasound, creatine kinase-MB, urinalysis, thyroid levels, and CBC were unremarkable. No other inherited conditions were identified in lab work. The patient was given dextrose 5% in water with sodium bicarbonate and switched to aggressive hydration via normal saline until discharge.
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Affiliation(s)
- Muhammad Y Nawaz
- College of Osteopathic Medicine, Campbell University School of Osteopathic Medicine, Lillington, USA
| | - Raza Hamdani
- Pediatrics, Campbell University School of Osteopathic Medicine, Lillington, USA
| | - Mishal K Siddiqui
- Pediatrics, Campbell University School of Osteopathic Medicine, Lillington, USA
| | - Neel Patel
- Pediatrics, Campbell University School of Osteopathic Medicine, Lillington, USA
| | - Khushmi Shah
- Pediatrics, Campbell University School of Osteopathic Medicine, Lillington, USA
| | - Lori Langdon
- Pediatrics, Campbell School of Osteopathic Medicine, Lillington, USA
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16
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Teschler M, Waranski M, Schmitz B, Mooren FC. Inter-individual differences in muscle damage following a single bout of high-intense whole-body electromyostimulation. Front Sports Act Living 2024; 6:1454630. [PMID: 39507491 PMCID: PMC11537929 DOI: 10.3389/fspor.2024.1454630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 10/09/2024] [Indexed: 11/08/2024] Open
Abstract
Purpose This brief report aimed to characterize inter-individual training responses following a single session of high-intense whole-body electromyostimulation (WB-EMS) using markers of muscle damage over a period of 72 h. Methods Twelve healthy individuals (5 men, 7 women; 32.0 ± 7 years) participated in a single 20-minute high-intensity WB-EMS training session. Markers of muscle damage, creatine kinase (CK) and myoglobin (Mb), were assessed before and immediately after training, as well as at 1.5, 3, 24, 48 and 72 h post-exercise. Lactate levels were determined pre- and post-exercise. Results Overall, WB-EMS induced significant CK elevations, peaking at 72 h (18.358 ± 21.380 U/L; p < 0.01), and correlating Mb levels peaking at 48 h (1.509 ± 1.394 ng/dl, p < 0.01). Despite significant inter-individual variability in CK levels, both slow (SR) and fast responders (FR) were identified. FR showed significant increases in CK at all time points post WB-EMS (p < 0.05), whereas CK in SR significantly elevated after 48 h. Post-WB-EMS lactate concentration was identified to predict peak CK and Mb levels (r ≥ 0.65, both p < 0.05). Conclusion High-intensity WB-EMS has the potential to induce severe muscle damage, as indicated by elevated levels of CK and Mb. We identified two distinct groups of individuals, SR and FR, indicating variability in response to WB-EMS. Furthermore, we suggest that individual responses to WB-EMS can be predicted based on post-WB-EMS lactate concentration.
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Affiliation(s)
- Marc Teschler
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Klinik Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Melina Waranski
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Klinik Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Boris Schmitz
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Klinik Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Frank C. Mooren
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Klinik Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
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17
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Qureshi M, Abraham PA, Al-Faras A, Bamasood OM, Matar KM. Rhabdomyolysis Induced by Levetiracetam: A Case Report in Kuwait. Case Rep Neurol Med 2024; 2024:1234738. [PMID: 39346748 PMCID: PMC11438511 DOI: 10.1155/2024/1234738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/27/2024] [Accepted: 07/18/2024] [Indexed: 10/01/2024] Open
Abstract
Epilepsy is a common disorder caused by a myriad of drugs, of that levetiracetam is being commonly used late because of its strong safety profile and efficacy. With the increasing usage of drugs, some rare side effects may sometimes appear that can escape the most stringent checks, possibly due to the rarity of their occurrence. Rhabdomyolysis is known to occur in some patients owing to a variety of causes, even leading to kidney injury. When a drug has a side effect that is not well recognized in the literature, especially when the side effect can mimic an adverse effect of an uncommon primary illness, identifying the causal factor can be doubly difficult. To date, only limited studies have been published suggesting rhabdomyolysis linked to levetiracetam use. We report the first case of levetiracetam-induced rhabdomyolysis in Kuwait.
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Affiliation(s)
- Moaz Qureshi
- Department of Internal MedicineAdan HospitalMinistry of Health, Kuwait City, Kuwait
| | - Prakash A. Abraham
- Department of Internal MedicineAdan HospitalMinistry of Health, Kuwait City, Kuwait
| | - Abdullah Al-Faras
- Department of Internal MedicineAdan HospitalMinistry of Health, Kuwait City, Kuwait
| | - Omar M. Bamasood
- Department of AnesthesiaAdan HospitalMinistry of Health, Kuwait City, Kuwait
| | - Kamal M. Matar
- Department of Pharmacology and TherapeuticsCollege of PharmacyKuwait University, Kuwait City, Kuwait
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18
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Shah SJ, Price MC, Kanjilal S. Case 29-2024: A 47-Year-Old Man with Confusion and Kidney Failure. N Engl J Med 2024; 391:1039-1048. [PMID: 39292931 DOI: 10.1056/nejmcpc2402492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Affiliation(s)
- Sachin J Shah
- From the Departments of Medicine (S.J.S.) and Radiology (M.C.P.), Massachusetts General Hospital, the Departments of Medicine (S.J.S.), Radiology (M.C.P.), and Population Medicine (S.K.), Harvard Medical School, the Department of Population Medicine, Harvard Pilgrim Health Care Institute (S.K.), and the Department of Medicine, Brigham and Women's Hospital (S.K.) - all in Boston
| | - Melissa C Price
- From the Departments of Medicine (S.J.S.) and Radiology (M.C.P.), Massachusetts General Hospital, the Departments of Medicine (S.J.S.), Radiology (M.C.P.), and Population Medicine (S.K.), Harvard Medical School, the Department of Population Medicine, Harvard Pilgrim Health Care Institute (S.K.), and the Department of Medicine, Brigham and Women's Hospital (S.K.) - all in Boston
| | - Sanjat Kanjilal
- From the Departments of Medicine (S.J.S.) and Radiology (M.C.P.), Massachusetts General Hospital, the Departments of Medicine (S.J.S.), Radiology (M.C.P.), and Population Medicine (S.K.), Harvard Medical School, the Department of Population Medicine, Harvard Pilgrim Health Care Institute (S.K.), and the Department of Medicine, Brigham and Women's Hospital (S.K.) - all in Boston
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19
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Zhang S, Yan MM, Zhao H, Qiu XY, Zhu D. Rhabdomyolysis associated with concomitant use of colchicine and statins in the real world: identifying the likelihood of drug-drug interactions through the FDA adverse event reporting system. Front Pharmacol 2024; 15:1445324. [PMID: 39351090 PMCID: PMC11439674 DOI: 10.3389/fphar.2024.1445324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 08/30/2024] [Indexed: 10/04/2024] Open
Abstract
Background Currently, there remains substantial controversy in research regarding whether the concomitant use of colchicine and statins increases the occurrence of rhabdomyolysis, warranting further substantiation. Objective This study aimed to identify the likelihood drug-drug interactions (DDIs) for the co-administration of colchicine and statins resulting in rhabdomyolysis. Methods A disproportionality analysis was conducted by using data sourced from the US Food and Drug Administration Adverse Event Reporting System (FAERS) to detect rhabdomyolysis signals associated with the combined use of colchicine and statins. The association between (colchicine/statins/colchicine and statins) and rhabdomyolysis were evaluated using information component (IC). DDI signals were calculated based on the Ω shrinkage measure and Bayesian confidence propagation neural network (BCPNN) method. Furthermore, stratification was performed based on colchicine and individual statins agents. Results In total, 11,119 reports of rhabdomyolysis were identified in the FAERS database, 255 (2.29%) involved both colchicine and statins. Our analysis showed potential DDI signals of rhabdomyolysis (Ω025 = 1.17) among individuals concurrent use of colchicine and statins. Moreover, further drug-specific analysis suggests DDI signals in the colchicine-atorvastatin pair (Ω025 = 1.12), and colchicine-rosuvastatin pair (Ω025 = 1.05), along with a higher proportion of rhabdomyolysis (IC025 = 5.20) and (IC025 = 4.26), respectively. Conclusion The findings suggest that concomitant use of colchicine and statins may increase the risk of rhabdomyolysis, particularly when combined with atorvastatin or rosuvastatin. Therefore, healthcare professionals should pay special attention to life-threatening AE such as rhabdomyolysis, when co-prescribing colchicine statins.
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Affiliation(s)
- Sha Zhang
- Department of Pharmacy, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ming-Ming Yan
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Hui Zhao
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Yan Qiu
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Deqiu Zhu
- Department of Pharmacy, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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20
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Lertsakulbunlue S, Sakboonyarat B, Suwanpakdee P, Boonyawat B. Recurrent Rhabdomyolysis in a Medical Cadet during Military Training as a Rare Initial Presentation in Calpainopathy. Case Rep Neurol Med 2024; 2024:2775517. [PMID: 39258114 PMCID: PMC11383649 DOI: 10.1155/2024/2775517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/30/2024] [Accepted: 08/24/2024] [Indexed: 09/12/2024] Open
Abstract
Rhabdomyolysis, an emergency medical condition linked to muscle necrosis and intracellular substances released into the bloodstream, significantly endangers military personnel in heat-stress conditions. Rhabdomyolysis can also be an initial presentation in inherited muscle disorders. This study reports a novel case of calpainopathy (LGMDR1) diagnosed in a 19-year-old male military cadet who initially presented with recurrent rhabdomyolysis during training, a rare presentation in LGMD patients. Furthermore, a persistent creatine kinase (CK) elevation was observed at baseline. The diagnosis was confirmed by identifying a compound heterozygous of a novel frameshift, c.606dup (p.Ala203CysfsTer9), a mutation in exon 4, and a missense, c.956C > T (p.Pro319Leu), a mutation in exon 7 of the CAPN3 gene, via whole exome sequencing. This case highlights the necessity of diagnostic investigation in individuals who have persistent high CK levels during the rhabdomyolysis episodes and possibly CK screening prior to military training to preemptively identify and mitigate complications from undiagnosed muscular dystrophies in military personnel in the future.
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Affiliation(s)
| | - Boonsub Sakboonyarat
- Department of Military and Community Medicine Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Piradee Suwanpakdee
- Division of Neurology Department of Pediatrics Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Boonchai Boonyawat
- Division of Medical Genetics Department of Pediatrics Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok 10400, Thailand
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21
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Chen Y, Zhang W, Cai J, Zhong M. Rhabdomyolysis following colorectal endoscopic submucosal dissection: A case report. Clin Case Rep 2024; 12:e9397. [PMID: 39262815 PMCID: PMC11388055 DOI: 10.1002/ccr3.9397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 08/15/2024] [Indexed: 09/13/2024] Open
Abstract
The occurrences of rhabdomyolysis after endoscopic submucosal dissection surgery were rarely reported. This is a case involving rhabdomyolysis affecting the muscles of the left buttocks and left hip following a prolonged endoscopic submucosal surgery.
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Affiliation(s)
- Ying Chen
- Department of Anesthesiology Guangdong Provincial Hospital of Traditional Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine) Guangzhou China
| | - Wenxuan Zhang
- Department of Anesthesiology Guangdong Provincial Hospital of Traditional Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine) Guangzhou China
| | - Junqiang Cai
- Department of Anesthesiology Guangdong Provincial Hospital of Traditional Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine) Guangzhou China
| | - Min Zhong
- Department of Anesthesiology Guangdong Provincial Hospital of Traditional Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine) Guangzhou China
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22
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Pinto JM, Ison G, Kasselman LJ, Naganathan S. Acute Kidney Injury in Rhabdomyolysis: A 5-Year Children's Hospital Network Study. Healthcare (Basel) 2024; 12:1717. [PMID: 39273741 PMCID: PMC11395255 DOI: 10.3390/healthcare12171717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/15/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
Rhabdomyolysis is a skeletal muscle injury that can cause myoglobinuria and acute kidney injury (AKI). Risk factors for AKI in children are not clearly understood with no standardized treatment guidelines for rhabdomyolysis. Our study explores factors associated with AKI and management of pediatric patients with rhabdomyolysis. Medical records from a children's hospital network over a 5-year period were retrospectively reviewed. The results are described with respect to the presence or absence of AKI. Of the 112 patients who met the inclusion criteria, AKI incidence was 7.1% (n = 8), with all affected patients having exertional etiology. The overall mean age was 13.5 years; patients without AKI were younger than patients with AKI (13.3 versus 17; p < 0.001). Using regression models for hypothesis generation, we found that patients with AKI were more likely to be older (OR = 1.44, 95%CI [1.11-2.19]; p = 0.03), have myoglobinuria (OR = 22.98, 95%CI [2.05-432.48]; p = 0.02), and have received intravenous bicarbonate (OR = 16.02, 95%CI [1.44-228.69]; p = 0.03). In our study, AKI was uncommon and associated with older age, myoglobinuria and bicarbonate treatment. Larger, prospective studies are needed to further understand AKI risk factors and optimal management of pediatric rhabdomyolysis.
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Affiliation(s)
- Jamie M Pinto
- Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ 07753, USA
- Hackensack Meridian School of Medicine, 123 Metro Boulevard, Nutley, NJ 07110, USA
| | - Gregory Ison
- Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ 07753, USA
| | - Lora J Kasselman
- Hackensack Meridian Health Research Institute, 111 Ideation Way, Nutley, NJ 07110, USA
| | - Srividya Naganathan
- Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ 07753, USA
- Hackensack Meridian School of Medicine, 123 Metro Boulevard, Nutley, NJ 07110, USA
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23
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Nayak M V, Bipasha F, Neelakantappa K. Asymptomatic COVID-19 Infection-Induced Rhabdomyolysis in the Backdrop of Statin-Cyclosporine Drug Interaction. Cureus 2024; 16:e68127. [PMID: 39347336 PMCID: PMC11438487 DOI: 10.7759/cureus.68127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 10/01/2024] Open
Abstract
Rhabdomyolysis involves skeletal muscle breakdown leading to high serum creatine kinase (CK) levels and myoglobinuria. Here, we report the case of a middle-aged man who developed rhabdomyolysis, resulting in acute kidney injury (AKI) over pre-existing chronic kidney disease (stage 3a) secondary to focal segmental glomerulosclerosis (primary FSGS), during an asymptomatic COVID-19 infection. The patient had been on treatment with cyclosporine and statin, among other drugs, for his comorbidities. He had initially presented to the hospital after a fall due to difficulty walking in the setting of increasing edema. Lab workup revealed elevated CK and AKI. Urinalysis showed "large" blood on a dipstick with only two RBCs per high-power field on microscopy, suggesting myoglobinuria. A standard respiratory pathogen polymerase chain reaction panel revealed positive SARS-CoV-2. The chest X-ray and oxygenation were normal, and he had no respiratory symptoms. He was treated with intravenous fluids and albumin, with a steady improvement in renal function. Our case underlines that rhabdomyolysis can occur in asymptomatic COVID-19 infection. Therefore, it may be worth monitoring CK levels in COVID-19-positive patients with risk factors for rhabdomyolysis, such as the concurrent usage of statins and cyclosporine, even if they are otherwise asymptomatic.
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Affiliation(s)
- Vivek Nayak M
- Internal Medicine, Kasturba Medical College, Manipal, Manipal, IND
| | - Fnu Bipasha
- Internal Medicine, Government Medical College and Hospital, Chandigarh, IND
- Internal Medicine, MedStar Union Memorial Hospital, Baltimore, USA
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24
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Buyle C, Vanclooster P, Platteeuw J, Mortelé P, Linden P, Floré P, Ryckaert T. Exertion induced rhabdomyolysis in both triceps muscles in a 36-year old woman: A case report. Radiol Case Rep 2024; 19:3308-3315. [PMID: 38817640 PMCID: PMC11137360 DOI: 10.1016/j.radcr.2024.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 06/01/2024] Open
Abstract
Rhabdomyolysis is a condition, often caused by strenuous exercise, which can lead to acute kidney injury, severe electrolyte imbalances, coagulopathies, compartment syndromes, and even have a fatal outcome in a few cases. Recognition and management of fluid and electrolyte abnormalities is one of the first steps of treatment and key to a good outcome. We report a case of a 36-year old woman who was referred to the ER by her general practitioner with severe muscle tenderness to the upper arms and highly elevated creatine kinase (CK) serum levels. Initial ultrasound imagery showed a patent venous system but demonstrated a moderate edematous infiltration of the muscle bellies of both m. triceps. Additional magnetic resonance imagery showed a hyperintense signal in T2 in both triceps' muscles. Given the clinical presentation, the MRI-findings were consistent with a form of exertion-induced rhabdomyolysis of both triceps' muscles. The patient was admitted for administration of IV-fluids to prevent acute kidney injury. Symptoms resolved in a few days and new magnetic resonance imagery showed a regression of the subcutaneous soft tissue infiltration. The aim of this paper is to raise awareness about this diagnosis. If overlooked, severe complications as mentioned above can occur.
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Affiliation(s)
- Cindy Buyle
- Department of Physical Therapy and Rehabilitation medicine, AZ Delta Hospital, Torhout/Roeselare, Belgium
| | - Pieter Vanclooster
- Department of Physical Therapy and Rehabilitation medicine, AZ Delta Hospital, Torhout/Roeselare, Belgium
| | - Joke Platteeuw
- Department of Physical Therapy and Rehabilitation medicine, AZ Delta Hospital, Torhout/Roeselare, Belgium
| | - Piet Mortelé
- Department of Physical Therapy and Rehabilitation medicine, AZ Delta Hospital, Torhout/Roeselare, Belgium
| | - Patrick Linden
- Department of Physical Therapy and Rehabilitation medicine, AZ Delta Hospital, Torhout/Roeselare, Belgium
| | - Pierre Floré
- Department of Physical Therapy and Rehabilitation medicine, AZ Delta Hospital, Torhout/Roeselare, Belgium
| | - Thomas Ryckaert
- Department of Radiology, AZ Delta Hospital, Roeselare, Belgium
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Skolka MP, Milone M, Litchy WJ, Laughlin RS, Rubin DI, Liewluck T. The utility of electrodiagnostic testing in unprovoked rhabdomyolysis in the era of next-generation sequencing. Muscle Nerve 2024; 70:180-186. [PMID: 38533679 DOI: 10.1002/mus.28087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 03/03/2024] [Accepted: 03/10/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION/AIMS Rhabdomyolysis is an etiologically heterogeneous, acute necrosis of myofibers characterized by transient marked creatine kinase (CK) elevation associated with myalgia, muscle edema, and/or weakness. The study aimed to determine the role of electrodiagnostic (EDX) testing relative to genetic testing and muscle biopsy in patients with unprovoked rhabdomyolysis in identifying an underlying myopathy. METHODS EDX database was reviewed to identify unprovoked rhabdomyolysis patients who underwent EDX testing between January 2012 and January 2022. Each patient's clinical profile, EDX findings, muscle pathology, laboratory, and genetic testing results were analyzed. RESULTS Of 66 patients identified, 32 had myopathic electromyography (EMG). Muscle biopsy and genetic testing were performed in 41 and 37 patients, respectively. A definitive diagnosis was achieved in 15 patients (11 myopathic EMG and 4 nonmyopathic EMG; p = .04) based on abnormal muscle biopsy (4/11 patients) or genetic testing (12/12 patients, encompassing 5 patients with normal muscle biopsy and 3 patients with nonmyopathic EMG). These included seven metabolic and eight nonmetabolic myopathies (five muscular dystrophies and three ryanodine receptor 1 [RYR1]-myopathies). Patients were more likely to have baseline weakness (p < .01), elevated baseline CK (p < .01), and nonmetabolic myopathies (p = .03) when myopathic EMG was identified. DISCUSSION Myopathic EMG occurred in approximately half of patients with unprovoked rhabdomyolysis, more likely in patients with weakness and elevated CK at baseline. Although patients with myopathic EMG were more likely to have nonmetabolic myopathies, nonmyopathic EMG did not exclude myopathy, and genetic testing was primarily helpful to identify an underlying myopathy. Genetic testing should likely be first-tier diagnostic testing following unprovoked rhabdomyolysis.
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Affiliation(s)
| | | | | | | | - Devon I Rubin
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Teerin Liewluck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Rosenfeld J, Boehm D, Raikar A, Coskey D, Lee M, Ji E, Lee Z. A review of complications after ureteral reconstruction. Asian J Urol 2024; 11:348-356. [PMID: 39139540 PMCID: PMC11318449 DOI: 10.1016/j.ajur.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/15/2023] [Indexed: 08/15/2024] Open
Abstract
Objective This study aimed to provide a comprehensive overview of the complications unique to ureteral reconstruction in adults, emphasizing their presentation, diagnosis, and management in the treatment of ureteral structure disease. Methods This review involves an in-depth analysis of existing literature and case studies pertaining to ureteral reconstruction, with a focus on examining the range of complications that can arise post-surgery. Special attention is given to the presentation of each complication, the diagnostic process involved, and the subsequent management strategies. Results Ureteral reconstruction can treat ureteral stricture disease with low morbidity; however, complications, although uncommon, can have severe consequences. The most notable complications include urinary extravasation, stricture recurrence, urinary tract infections, compartment syndrome, symptomatic vesicoureteral reflux, and Boari flap necrosis. Each complication presents unique diagnostic challenges and requires specific management approaches. Conclusion Ureteral reconstruction is a highly effective treatment for ureteral stricture disease. Having a strong understanding of the potential complications that patients may experience following ureteral reconstruction is not only critical to adequately counsel patients but also facilitate prompt diagnosis and management of complications when they arise.
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Affiliation(s)
- Jonathan Rosenfeld
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Devin Boehm
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Aidan Raikar
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Devyn Coskey
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew Lee
- Department of Urology, Temple University, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Emily Ji
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Ziho Lee
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Araujo AQC, Lima MA, Silva MTT. Neurodengue, a narrative review of the literature. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-11. [PMID: 38964367 DOI: 10.1055/s-0044-1787799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
Dengue fever (DF) is the most frequent arboviral disease globally. Deforestation, armed conflicts, and climate change have caused an unprecedented global spread of DF, raising concerns in healthcare systems worldwide. Systemic manifestations of the disease range from mild to severe and, in some cases, can lead to death. Although neurological complications have been reported over the last few decades, they are often neglected or underreported. The present narrative review aims to describe the most important central and peripheral nervous system complications and provide guidance to neurologists in terms of diagnosis and management.
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Affiliation(s)
- Abelardo Queiroz Campos Araujo
- Fundação Oswaldo Cruz, Instituto Nacional de Doenças Infecciosas, Laboratório de Pesquisa Clínica em Neuroinfecção
- Universidade Federal do Rio de Janeiro, Instituto de Neurologia Deolindo Couto, Rio de Janeiro RJ, Brazil
| | - Marco Antonio Lima
- Fundação Oswaldo Cruz, Instituto Nacional de Doenças Infecciosas, Laboratório de Pesquisa Clínica em Neuroinfecção
- Universidade Federal do Rio de Janeiro, Seção de Neurologia, Rio de Janeiro RJ, Brazil
| | - Marcus Tulius Teixeira Silva
- Fundação Oswaldo Cruz, Instituto Nacional de Doenças Infecciosas, Laboratório de Pesquisa Clínica em Neuroinfecção
- Complexo Hospitalar de Niterói, Departamento de Neurologia, Niterói RJ, Brazil
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B. Abo-Zalam H, El Denshary EED, A. Abdalsalam R, A. Khalil I, M. Khattab M, A. Hamzawy M. Revolutionizing Hyperlipidemia Treatment: Nanoencapsulated CoQ10 and Selenium Combat Simvastatin-Induced Myopathy and Insulin Resistance in Rats. Adv Pharm Bull 2024; 14:364-377. [PMID: 39206395 PMCID: PMC11347742 DOI: 10.34172/apb.2024.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/03/2023] [Accepted: 09/20/2023] [Indexed: 09/04/2024] Open
Abstract
Purpose The objective of this study was to develop a nanoencapsulated platform for coenzyme Q10 nanoparticles (coQNPs) or selenium nanoparticles (SeNPs) and explore their potential therapeutic benefits in treating hyperlipidemia and combating simvastatin (SV)-induced myopathy and adverse reactions in hyperlipidemic rats. Methods The physical and chemical properties of the solid nanoparticles, coQNPs, and SeNPs were characterized, including zeta potential studies. Male Wistar albino rats were treated with various interventions for 112 days, including a nano-vehicle only, high-fat diet (HFD), HFD with SV alone, or with coQNPs or/and SeNPs for the last 30 days. Results The coQNPs and SeNPs exhibited uniform spherical shapes with high encapsulation efficiency (EE% 91.20±2.14 and 94.89±1.54, respectively). The results demonstrated that coQNPs and SeNPs effectively reduced hyperlipidemia, insulin resistance, SV-induced myopathy, and hepatotoxicity. However, combining SV with coQNPs and SeNPs resulted in severe liver and muscle damage. Treatment with SV and SeNPs or SV and coQNPs alone showed significant improvements compared to SV treatment alone. Conclusion These findings suggest that the CoQNPs or SeNPs platforms offer advanced relief for hyperlipidemia and insulin resistance while limiting adverse effects such as myopathy and hepatotoxicity.
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Affiliation(s)
- Hagar B. Abo-Zalam
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, 6th of October University, 6th of October, Giza, Egypt
| | - Ezz El Deen El Denshary
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Rania A. Abdalsalam
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
- School of Pharmacy, New Giza University, Giza, Egypt
| | - Islam A. Khalil
- Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy and Drug Manufacturing, Misr University of Science and Technology (MUST), 6th of October, Giza, (12566) Egypt
| | - Mahmoud M. Khattab
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Mohamed A. Hamzawy
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Fayoum University, Fayoum, Egypt
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Zhai W, Liu H, Li J, Xin H. Pregabalin-induced rhabdomyolysis: a case series and literature analysis. J Int Med Res 2024; 52:3000605241257776. [PMID: 38879799 PMCID: PMC11181883 DOI: 10.1177/03000605241257776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/01/2024] [Indexed: 06/19/2024] Open
Abstract
Pregabalin is a prescription medicine that has recently been approved for individuals who suffer from fibromyalgia, neuropathic pain, anxiety disorder, or epilepsy. Pregabalin has the side effects of dizziness, sleepiness, and angioedema. Pregabalin-induced rhabdomyolysis has been rarely reported, with only four reports to date. We report two cases of rhabdomyolysis after pregabalin treatment. A man aged older than 90 years presented with exhaustion, muscle aches, and a high serum creatine kinase concentration after taking 75 mg of pregabalin on the first day of treatment. A woman in her 90s with long-term use of pregabalin presented with considerably elevated serum creatine kinase concentrations. Both patients had a long history of taking statins. Pregabalin therapy was stopped, high-volume intravenous fluids were administered, and serum electrolytes were frequently checked. Alkalinisation was performed with excellent outcomes. The Naranjo Adverse Drug Reaction scale and previous research suggest an association between pregabalin and rhabdomyolysis. Clinicians should be alert to the possibility of rhabdomyolysis occurring with the use of pregabalin, especially when taking statins.
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Affiliation(s)
- Wenjing Zhai
- Jingdong Medical Area of PLA General Hospital, Beijing, China
| | - Hao Liu
- Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, China
| | - Jinrui Li
- Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, China
| | - Haili Xin
- Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, China
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Patel JP, Saiyed F, Hardaswani D. Dengue Fever Accompanied by Neurological Manifestations: Challenges and Treatment. Cureus 2024; 16:e60961. [PMID: 38910682 PMCID: PMC11193856 DOI: 10.7759/cureus.60961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
Dengue, commonly referred to as 'breakbone fever,' is a mosquito-borne arboviral infection transmitted by Aedes aegypti, featuring an average incubation period of approximately seven days. Key cytokines such as interferon-gamma (IFN-γ), tumor necrosis factor (TNF)-α, and interleukin (IL)-10 are pivotal in the pathogenesis of dengue. Travelers are particularly susceptible to contracting dengue fever, with disease severity often associated with CD8+ T cell response. Without proper hospitalization during severe cases like dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS), mortality rates can escalate to 50%. Dengue fever can lead to various complications, including neurological manifestations such as encephalopathy, encephalitis, cerebral venous thrombosis, myelitis, posterior reversible encephalopathy syndrome, strokes (both ischemic and hemorrhagic), immune-mediated neurological syndromes (such as mononeuropathy, acute transverse myelitis, Guillain-Barre syndrome, and acute disseminated encephalomyelitis), and neuromuscular complications. Treatment protocols typically involve assessing disease activity using composite indices, pursuing treatment objectives, and administering intravenous fluids according to symptomatology. Given the absence of specific antiviral treatment for dengue, supportive care, particularly hydration, remains paramount during the early stages. It is crucial to recognize that dengue viruses may contribute to the development of neurological disorders, particularly in regions where dengue is endemic. Furthermore, there is a necessity for well-defined criteria for specific neurological complications. Primary prevention strategies primarily revolve around vector control measures, which play a critical role in curtailing the spread of dengue.
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Affiliation(s)
- Jay P Patel
- Research, Chirayu Medical College and Hospital, Bhopal, IND
| | - Faizanali Saiyed
- Internal Medicine, Odessa National Medical University, Odessa, UKR
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Ehelepola NDB, Ranathunga RMDC, Abeysundara AB, Jayawardana HMRP, Nanayakkara PSK. Super-refractory status epilepticus, rhabdomyolysis, central hyperthermia and cardiomyopathy attributable to spinal anesthesia: a case report and review of literature. BMC Anesthesiol 2024; 24:132. [PMID: 38582882 PMCID: PMC10998312 DOI: 10.1186/s12871-024-02485-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/07/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND There are only six past reports of super-refractory status epilepticus induced by spinal anesthesia. None of those patients have died. Only < 15 mg of bupivacaine was administered to all six of them and to our case. Pathophysiology ensuing such cases remains unclear. CASE PRESENTATION A 27 year old gravida 2, para 1, mother at 37 weeks of gestation came to the operating theater for an elective cesarean section. She had no significant medical history other than controlled hypothyroidism and one episode of food allergy. Her current pregnancy was uneventful. Her American Society of Anesthesiologists (ASA) grade was 2. She underwent spinal anesthesia and adequate anesthesia was achieved. After 5-7 min she developed a progressive myoclonus. After delivery of a healthy baby, she developed generalized tonic clonic seizures that continued despite the induction of general anesthesia. She had rhabdomyolysis, one brief cardiac arrest and resuscitation, followed by stress cardiomyopathy and central hyperthermia. She died on day four. There were no significant macroscopic or histopathological changes in her brain that explain her super refractory status epilepticus. Heavy bupivacaine samples of the same batch used for this patient were analyzed by two specialized laboratories. National Medicines Quality Assurance Laboratory of Sri Lanka reported that samples failed to confirm United States Pharmacopeia (USP) dextrose specifications and passed other tests. Subsequently, Therapeutic Goods Administration of Australia reported that the drug passed all standard USP quality tests applied to it. Nonetheless, they have detected an unidentified impurity in the medicine. CONCLUSIONS After reviewing relevant literature, we believe that direct neurotoxicity by bupivacaine is the most probable cause of super-refractory status epilepticus. Super-refractory status epilepticus would have led to her other complications and death. We discuss probable patient factors that would have made her susceptible to neurotoxicity. The impurity in the drug detected by one laboratory also would have contributed to her status epilepticus. We propose several possible mechanisms that would have led to status epilepticus and her death. We discuss the factors that shall guide investigators on future such cases. We suggest ways to minimize similar future incidents. This is an idiosyncratic reaction as well.
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Affiliation(s)
- N D B Ehelepola
- Teaching (General) Hospital - Peradeniya, Peradeniya, Sri Lanka.
| | | | - A B Abeysundara
- Teaching (General) Hospital - Peradeniya, Peradeniya, Sri Lanka
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - P S K Nanayakkara
- Teaching (General) Hospital - Peradeniya, Peradeniya, Sri Lanka
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Yu M, Zhang C, Wan S, Lu Y, Wang Y, Liu T, Wang H, Chen W, Liu Y. NEW PREDICTIVE BIOMARKERS FOR SCREENING COVID-19 PATIENTS WITH RHABDOMYOLYSIS IN COMBINATION WITH CYSTATIN C. Shock 2024; 61:549-556. [PMID: 38010067 DOI: 10.1097/shk.0000000000002258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT Purpose: Cystatin C (CysC) has been linked to the prognosis of corona virus disease 2019 (COVID-19). The study aims to investigate a predictor correlated with CysC screening for poor prognosis in COVID-19 patients combined with skeletal muscle (SKM) impairment and rhabdomyolysis (RM). Methods: A single-center retrospective cohort analysis was carried out. Demographic information, clinical data, laboratory test results, and clinical outcome data were gathered and analyzed. Results: According to the inclusion and exclusion criteria, 382 patients were included in this study. The subjects were divided into three groups based on CysC tertiles. Multivariate analysis revealed that SaO 2 (hazard ratio [HR], 0.946; 95% confidence interval [CI], 0.906-0.987; P = 0.011), CysC (HR, 2.124; 95% CI, 1.223-3.689; P = 0.008), aspartate aminotransferase (AST) (HR, 1.009; 95% CI, 1.000-1.018; P = 0.041), and hypersensitive C-reactive protein (HR, 1.005; 95% CI, 1.000-1.010; P = 0.045) were significantly associated with survivals. The area under curve (AUC) in the model characterized by RM incidence was 0.819 (0.698-0.941), as shown by CysC receiver operating characteristic curves. LDH*CysC and AST*CysC had better predictive values than CysC and the best prediction for RM, with an AUC of 0.880 (0.796,0.964) for LDH*CysC ( P < 0.05, vs CysC) and 0.925 (0.878,0.972) for AST*CysC ( P < 0.05, vs CysC). Conclusion: CysC is an essential evaluation indicator for COVID-19 patients' prognosis. AST*CysC and LDH*CysC have superior predictive value to CysC for SKM, RM, and death, and optimal classification for RM.
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Affiliation(s)
- Mengyang Yu
- General Medicine Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Chengying Zhang
- General Medicine Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Sitong Wan
- Department of Nutrition and Health, Beijing Advanced Innovation Center for Food Nutrition and Human Health, Key Laboratory of Precision Nutrition and Food Quality, China Agricultural University, Beijing, China
| | - Yang Lu
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Yufei Wang
- Clinical Laboratory Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Ting Liu
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Huimin Wang
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Wei Chen
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
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Omote D, Kuramoto N. A Case of Rhabdomyolysis Induced by Antipsychotic Medication With Creatine Kinase (CK) Levels Elevated to 420,000 U/L, Resulting in Acute Kidney Injury (AKI) and Necessitating Hemodialysis. Cureus 2024; 16:e58145. [PMID: 38741842 PMCID: PMC11088958 DOI: 10.7759/cureus.58145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
A 45-year-old man on public welfare, who had been visiting a psychiatric hospital for schizoaffective disorder, began working as a package delivery person for the first time in the morning after receiving welfare. In the afternoon, he noticed pain in his lower back. By evening, he was unable to move, prompting an emergency call and transportation to our hospital. Blood tests revealed renal damage and elevated creatine kinase (CK) levels, resulting in hospitalization. Although he received fluid replacement after admission, he did not urinate, and his CK levels increased to 420,000 U/L, necessitating hemodialysis. Subsequently, his CK levels gradually improved over time, accompanied by increased urine output. Approximately three weeks after initiating hemodialysis, he was weaned off the treatment and discharged home 40 days after admission.
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Affiliation(s)
- Daichi Omote
- Nephrology, Narita Red Cross Hospital, Narita-shi, JPN
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Mitsuboshi S, Morizumi M, Kotake K, Kaseda R, Narita I. Urate-Lowering Drugs and Muscle Injury: A Systematic Review and Network Meta-Analysis. J Clin Pharmacol 2024; 64:288-299. [PMID: 37840156 DOI: 10.1002/jcph.2369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023]
Abstract
Several urate-lowering drugs have been linked to muscle injury. This study investigated the association of oral urate-lowering drugs with the risk of muscle injury by performing a network meta-analysis of randomized and non-randomized controlled trials. A systematic search of MEDLINE, via PubMed, the ClinicalTrials.gov website, and the Cochrane Central Register of Controlled Trials was conducted to identify relevant studies with a primary outcome of "all muscle injuries." A random-effects model was used to perform a frequentist network meta-analysis to estimate whether there was significant heterogeneity among the studies. In total, 32 studies including 28,327 participants with 2694 (9.5%) "all muscle injuries" were assessed, and the overall risk of bias was judged to be low to moderate. No statistically significant differences were found between placebo and 6 urate-lowering therapies: allopurinol (risk ratio, RR, 1.05; 95% confidence interval, 95%CI, 0.63-1.73), febuxostat (RR 1.10, 95%CI 0.71-1.70), lesinurad (RR 7.00, 95%CI 0.31-160.36), lesinurad concomitant with allopurinol (RR 0.85, 95%CI 0.34-2.11), lesinurad concomitant with febuxostat (RR 1.97, 95%CI 0.55-7.03), and topiroxostat (RR 0.99, 95%CI 0.37-2.65). The findings suggest that there is little need to consider the risk of muscle injury when using urate-lowering drugs in the clinical setting.
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Affiliation(s)
| | - Makoto Morizumi
- Department of Pharmacy, Ohno Memorial Hospital, Osaka, Japan
| | - Kazumasa Kotake
- Department of Pharmacy, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Ryohei Kaseda
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Soliman N, Alsultan M, Alhusseini A, Alsamarrai O, Basha K. Status epilepticus resulted in rhabdomyolysis-induced AKI associated with hepatotoxicity induced by synergistic carbamazepine and diazepam: A case report. Medicine (Baltimore) 2024; 103:e36834. [PMID: 38394513 PMCID: PMC11309705 DOI: 10.1097/md.0000000000036834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/11/2023] [Indexed: 02/25/2024] Open
Abstract
RATIONALE Rhabdomyolysis is a serious complication of status epilepticus (SE) caused by muscle cell damage and can lead to a life-threatening acute kidney injury (AKI). PATIENT CONCERNS A 35-year-old man with a history of seizures treated with 3 different antiepileptic drugs (carbamazepine, lamotrigine, and levetiracetam) presented with SE. The patient received 5 doses of diazepam to control the SE in another hospital and was transferred to our emergency due to AKI. DIAGNOSES Laboratory tests corresponded with rhabdomyolysis-induced AKI and disseminated intravascular coagulation. Thereafter, the decrease in renal excretion of both drugs (diazepam and carbamazepine) caused acute liver injury and neurotoxicity. The carbamazepine concentration was 16.39 mcg/mL, which considered in toxic level, despite using the usual dose. INTERVENTIONS The patient was treated with hydration and sodium bicarbonate, however; severe AKI mandated a hemodialysis session. OUTCOMES The diuresis started to increase, kidney and liver functions improved, and altered mental status reversed. LESSONS This case alerts physicians to consider the synergistic drug side effects and interactions, especially when patients present with impaired liver or kidney functions. The reduction in metabolism or excretion of drugs can cause an increase in serum concentrations and induce toxicity, even when the drug intake at the usual dose.
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Affiliation(s)
- Nawwar Soliman
- Department of Internal Medicine, Al Assad and Al Mouwasat University Hospitals, Damascus University, Faculty of Medicine, Damascus, Syria
| | - Mohammad Alsultan
- Department of Nephrology, Al Assad and Al Mouwasat University Hospitals, Damascus University, Faculty of Medicine, Damascus, Syria
| | - Ayham Alhusseini
- Department of Neurology, Al Assad and Al Mouwasat University Hospitals, Damascus University, Faculty of Medicine, Damascus, Syria
| | - Omar Alsamarrai
- Department of Neurology, Al Assad and Al Mouwasat University Hospitals, Damascus University, Faculty of Medicine, Damascus, Syria
| | - Kassem Basha
- Nephrology Department, Al Mouwasat University Hospital, Damascus University, Faculty of Medicine, Damascus, Syria
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Varadarajan R, Patel A, Salah H, Sutaria N, Barrios R, Truong L, Gaber L, El-Zaatari ZM. Myoglobin Cast Nephropathy Diagnosed on Renal Biopsy in a Patient Treated for Malarial Infection. Case Rep Nephrol 2024; 2024:6764335. [PMID: 38375068 PMCID: PMC10876304 DOI: 10.1155/2024/6764335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 02/21/2024] Open
Abstract
Myoglobin cast nephropathy occurs in cases of acute renal injury in which large amounts of myoglobin accumulate in the renal tubules, presenting as muscle pain, reddish-brown urine, and elevated creatine kinase levels. Our case describes a 60-year-old male who came to the emergency department with fevers, mild abdominal pain, and constitutional symptoms one day after returning to the United States from a trip to Nigeria. Initial workup demonstrated an acute kidney injury and elevated aminotransferase levels and the patient was started onatovaquone-proguanil for possible malaria given a recent diagnosis in Nigeria. Two days later, the patient was found to have rhabdomyolysis, resulting in a renal biopsy that showed myoglobin cast nephropathy. Previous literature has suggested mechanisms for the development of rhabdomyolysis in malarial infection, including inflammatory processes, direct effect of parasite accumulation, and drug-induced toxicity. Our case further implicates antimalarial therapy as a cause of rhabdomyolysis and increases awareness of myoglobin cast nephropathy as a potential complication of malaria.
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Nwaneri C, Aboshehata AM, Marsh AR. Rhabdomyolysis Following Prolonged Entrapment on a Fence: A Case Report. Cureus 2024; 16:e51954. [PMID: 38333438 PMCID: PMC10852201 DOI: 10.7759/cureus.51954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
It is well documented that prolonged immobilization and heavy alcohol consumption can independently cause rhabdomyolysis; however, entrapment on a fence following alcohol consumption resulting in rhabdomyolysis without prolonged coma or seizures has not been reported. We report a case of a 25-year-old man who, following alcohol consumption, whilst attempting to climb a fence, became entrapped and desperately had to clinch on the fence with both forearms for over three hours, resulting in rhabdomyolysis. This case report highlights the importance of recognizing the potential complications associated with prolonged immobilization and the subsequent management of rhabdomyolysis.
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Affiliation(s)
- Chukwuemeka Nwaneri
- Department of Emergency Medicine, Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, GBR
| | - Ahmed M Aboshehata
- Department of Emergency Medicine, Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, GBR
| | - Adrian R Marsh
- Department of Emergency Medicine, Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, GBR
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Kakde U, Khatib MN. Neurological Complications in Dengue Among Males of the Adult Age Group. Cureus 2024; 16:e51586. [PMID: 38313931 PMCID: PMC10835196 DOI: 10.7759/cureus.51586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
Neurological problems are more frequently linked to dengue, a mosquito-transmitted virus common in tropical areas. This review study thoroughly examines the effects of dengue on adult males' neurological systems. Dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) can develop in severe cases of dengue fever caused by the dengue virus (DENV). Unsettlingly, it is thought that a sizable portion of DENV infections impact the central nervous system (CNS), which calls into question the former theory that the DENV is not neurotropic. This review dissects the many neurological manifestations of dengue, spanning from encephalopathy, encephalitis, and other CNS implications to peripheral neuromuscular issues, through the systematic analysis of publications gathered from PubMed. The essay emphasizes the immunological reactions brought on by DENV infections and offers a deeper understanding of the pathophysiology. Given that they exhibit similar first symptoms, Zika and chikungunya are two more illnesses that must be distinguished from dengue. The mainstay of current diagnostic methods is serum and cerebrospinal fluid (CSF) tests, although supportive care is still used. This review highlights the importance of tracking neurological symptoms in dengue patients and encourages more studies in this area.
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Affiliation(s)
- Umesh Kakde
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Research and Higher Education, Wardha, IND
| | - Mahalaqua Nazli Khatib
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Guerrero-Hue M, Vallejo-Mudarra M, García-Caballero C, Córdoba-David GM, Palomino-Antolín A, Herencia C, Vendrell-Casana B, Rubio-Navarro A, Egido J, Blanco-Colio LM, Moreno JA. Tweak/Fn14 system is involved in rhabdomyolysis-induced acute kidney injury. Biomed Pharmacother 2023; 169:115925. [PMID: 38007933 DOI: 10.1016/j.biopha.2023.115925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/07/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Rhabdomyolysis is a severe clinical syndrome associated to acute kidney injury (AKI) and chronic kidney disease (CKD). TWEAK/Fn14 signaling axis regulates renal inflammation and tubular cell death. However, the functional role of TWEAK/Fn14 in rhabdomyolysis remains unknown. METHODS Rhabdomyolysis was induced in wild-type, TWEAK- and Fn14-deficient mice or mice treated with TWEAK blocking antibody. Renal injury, inflammation, fibrosis and cell death were assessed. Additionally, we performed in vivo and in vitro studies to explore the possible signalling pathways involved in Fn14 regulation. FINDINGS Fn14 renal expression was increased in mice with rhabdomyolysis, correlating with decline of renal function. Mechanistically, myoglobin (Mb) induced Fn14 expression via ERK and p38 pathway, whereas Nrf2 activation diminished Mb-mediated Fn14 upregulation in cultured renal cells. TWEAK or Fn14 genetic depletion ameliorated rhabdomyolysis-associated loss of renal function, histological damage, tubular cell death, inflammation, and expression of both tubular and endothelial injury markers. Deficiency of TWEAK or Fn14 also decreased long-term renal inflammation and fibrosis in mice with rhabdomyolysis. Finally, pharmacological treatment with a blocking TWEAK antibody diminished the expression of acute renal injury markers and cell death and lessened residual kidney fibrosis and chronic inflammation in rhabdomyolysis. INTERPRETATION TWEAK/Fn14 axis participates in the pathogenesis of rhabdomyolysis-AKI and subsequent AKI-CKD transition. Blockade of this signaling pathway may represent a promising therapeutic strategy for reducing rhabdomyolysis-mediated renal injury. FUNDING Spanish Ministry of Science and Innovation, ISCIII and Junta de Andalucía.
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Affiliation(s)
- Melania Guerrero-Hue
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Mercedes Vallejo-Mudarra
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Cristina García-Caballero
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Gina Marcela Córdoba-David
- Renal, Vascular and Diabetes Research Lab, Fundación Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Autonoma University, Madrid, Spain
| | - Alejandra Palomino-Antolín
- Molecular Neuroinflammation and Neuronal Plasticity Research Laboratory, Hospital Universitario Santa Cristina, Instituto de Investigación Sanitaria-Hospital Universitario de la Princesa, Madrid, Spain; Instituto Teófilo Hernando, Departamento de Farmacología y Terapéutica, Facultad de Medicina, Autonoma University, Madrid, Spain
| | - Carmen Herencia
- Renal, Vascular and Diabetes Research Lab, Fundación Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Autonoma University, Madrid, Spain
| | - Beatriz Vendrell-Casana
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Alfonso Rubio-Navarro
- Laboratory of Advanced Therapies: Differentiation, Regeneration and Cancer (CTS-963). Center of Biomedical Research. University of Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain; Excellence Research Unit "Modeling Nature" (MNat), University of Granada, Granada, Spain
| | - Jesús Egido
- Renal, Vascular and Diabetes Research Lab, Fundación Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Autonoma University, Madrid, Spain; Centre of Biomedical Research in Network of Diabetes and Metabolic Disease Associated (CIBERDEM), Madrid, Spain
| | - Luis Miguel Blanco-Colio
- Renal, Vascular and Diabetes Research Lab, Fundación Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Autonoma University, Madrid, Spain; Centre of Biomedical Research in Network of Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Juan Antonio Moreno
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Hospital Universitario Reina Sofía, Cordoba, Spain; Centre of Biomedical Research in Network of Cardiovascular Diseases (CIBERCV), Madrid, Spain; Department of Cell Biology, Physiology and Immunology, University of Cordoba, Cordoba, Spain.
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Buonsenso A, Centorbi M, Di Martino G, Della Valle C, Di Claudio G, Di Fonza D, Di Zazzo E, Calcagno G, di Cagno A, Fiorilli G. Acute Effects of Combining Whole-Body Electromyostimulation with Resistance Training in Active Women. J Funct Morphol Kinesiol 2023; 9:10. [PMID: 38249087 PMCID: PMC10801553 DOI: 10.3390/jfmk9010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Strength training elicits benefits both in performance and on a psychological level in women, such as increased muscle strength and improved self-esteem. Whole-body electromyostimulation (WB-EMS) could be a training strategy for enhancing muscular strength. The aim of this study was to assess the acute effects of a single session of WB-EMS superimposed over classic resistance training on isometric strength, endurance strength and flexibility. Furthermore, the safety of the protocol was assessed by monitoring the levels of creatine kinase (CK) 48 h after the training protocol was completed. Sixteen active women (aged 22.06 ± 1.88) were randomly assigned to an experimental group (EG) (n = 8) and a control group (CG) (n = 8). The EG performed four sets of 12 repetitions of three strength exercises with superimposed WB-EMS, while the CG performed the same protocol without WB-EMS. RM-ANOVA showed a significant time*group interaction on posterior kinetic chain extensors' mean and peak strength in the EG (F(1,14) = 10.036; p = 0.007; and F(1,14) = 20.719; p < 0.001; respectively). A significant time*group interaction was found in the sit and reach test for the EG (F(1,14) = 10.362; p = 0.006). Finally, ANOVA performed on the CK levels showed no significant difference between the groups (F(1,14) = 0.715; p = 0.412). WB-EMS training led to an immediate improvement in strength performance and flexibility, and this protocol was shown to be safe in terms of CK levels, 48 h after completing the training protocol.
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Affiliation(s)
- Andrea Buonsenso
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (A.B.); (M.C.); (G.D.M.); (C.D.V.); (G.D.C.); (D.D.F.); (E.D.Z.); (G.C.); (G.F.)
| | - Marco Centorbi
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (A.B.); (M.C.); (G.D.M.); (C.D.V.); (G.D.C.); (D.D.F.); (E.D.Z.); (G.C.); (G.F.)
| | - Giulia Di Martino
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (A.B.); (M.C.); (G.D.M.); (C.D.V.); (G.D.C.); (D.D.F.); (E.D.Z.); (G.C.); (G.F.)
| | - Carlo Della Valle
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (A.B.); (M.C.); (G.D.M.); (C.D.V.); (G.D.C.); (D.D.F.); (E.D.Z.); (G.C.); (G.F.)
- Department of Neuroscience, Biomedicine, and Movement, University of Verona, 37124 Verona, Italy
| | - Gloria Di Claudio
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (A.B.); (M.C.); (G.D.M.); (C.D.V.); (G.D.C.); (D.D.F.); (E.D.Z.); (G.C.); (G.F.)
| | - Domenico Di Fonza
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (A.B.); (M.C.); (G.D.M.); (C.D.V.); (G.D.C.); (D.D.F.); (E.D.Z.); (G.C.); (G.F.)
| | - Erika Di Zazzo
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (A.B.); (M.C.); (G.D.M.); (C.D.V.); (G.D.C.); (D.D.F.); (E.D.Z.); (G.C.); (G.F.)
| | - Giuseppe Calcagno
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (A.B.); (M.C.); (G.D.M.); (C.D.V.); (G.D.C.); (D.D.F.); (E.D.Z.); (G.C.); (G.F.)
| | - Alessandra di Cagno
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Giovanni Fiorilli
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (A.B.); (M.C.); (G.D.M.); (C.D.V.); (G.D.C.); (D.D.F.); (E.D.Z.); (G.C.); (G.F.)
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Yılmaz-Gümüş E, Elcioglu NH, Genç E, Arıcı Ş, Öztürk G, Yapıcı Ö, Akalın F, Öztürk-Hişmi B. Management of acute metabolic crisis in TANGO2 deficiency: a case report. J Pediatr Endocrinol Metab 2023; 36:983-987. [PMID: 37381587 DOI: 10.1515/jpem-2023-0172] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES TANGO2 deficiency is a rare inborn error of metabolism, with distinct clinical features. The clinical presentations of TANGO2 deficiency are developmental delay, speech difficulties, intellectual disability, non-life-threatening paroxysmal neurologic episodes (TANGO2 spells), acute metabolic crises, cardiac crises, seizures and hypothyroidism. Patients may die in acute metabolic crises. Here we report our experience in the management of an acute metabolic crisis in TANGO2 deficiency. CASE PRESENTATION A 9-year-old patient diagnosed with TANGO2 deficiency was admitted with fever, fatigue, unable to walk. In follow up, encephalopathy, rhabdomyolysis and arrhythmia were detected. Vitamin B-complex was started. Our patient's mental status and rhabdomyolysis improved dramatically, and cardiac crises ended without Torsades de pointes, ventricular tachycardia and/or fibrillation or myocardial dysfunction. CONCLUSIONS With this report, we aimed to show the effectiveness of vitamin B-complex in the management of acute metabolic crises.
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Affiliation(s)
- Emel Yılmaz-Gümüş
- Department of Pediatrics, Division of Pediatric Metabolic Diseases, Marmara University School of Medicine, Istanbul, Türkiye
| | - Nursel H Elcioglu
- Department of Pediatrics, Division of Pediatric Genetics, Marmara University School of Medicine, Istanbul, Türkiye
- Eastern Mediterranean University School of Medicine, Famagusta, Türkiye
| | - Emine Genç
- Department of Pediatrics, Division of Pediatric Metabolic Diseases, Marmara University School of Medicine, Istanbul, Türkiye
| | - Şule Arıcı
- Department of Pediatrics, Division of Pediatric Cardiology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Gülten Öztürk
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Özge Yapıcı
- Department of Pediatric Radiology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Figen Akalın
- Department of Pediatrics, Division of Pediatric Cardiology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Burcu Öztürk-Hişmi
- Department of Pediatrics, Division of Pediatric Metabolic Diseases, Marmara University School of Medicine, Istanbul, Türkiye
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Hsia CCW. Tissue Perfusion and Diffusion and Cellular Respiration: Transport and Utilization of Oxygen. Semin Respir Crit Care Med 2023; 44:594-611. [PMID: 37541315 DOI: 10.1055/s-0043-1770061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
This article provides an overview of the journey of inspired oxygen after its uptake across the alveolar-capillary interface, and the interplay among tissue perfusion, diffusion, and cellular respiration in the transport and utilization of oxygen. The critical interactions between oxygen and its facilitative carriers (hemoglobin in red blood cells and myoglobin in muscle cells), and with other respiratory and vasoactive molecules (carbon dioxide, nitric oxide, and carbon monoxide), are emphasized to illustrate how this versatile system dynamically optimizes regional convective transport and diffusive gas exchange. The rates of reciprocal gas exchange in the lung and the periphery must be well-matched and sufficient for meeting the range of energy demands from rest to maximal stress but not excessive as to become toxic. The mobile red blood cells play a vital role in matching tissue perfusion and gas exchange by dynamically regulating the controlled uptake of oxygen and communicating regional metabolic signals across different organs. Intracellular oxygen diffusion and facilitation via myoglobin into the mitochondria, and utilization via electron transport chain and oxidative phosphorylation, are summarized. Physiological and pathophysiological adaptations are briefly described. Dysfunction of any component across this integrated system affects all other components and elicits corresponding structural and functional adaptation aimed at matching the capacities across the entire system and restoring equilibrium under normal and pathological conditions.
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Affiliation(s)
- Connie C W Hsia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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de Bruyn A, Montagnese F, Holm-Yildiz S, Scharff Poulsen N, Stojkovic T, Behin A, Palmio J, Jokela M, De Bleecker JL, de Visser M, van der Kooi AJ, Ten Dam L, Domínguez González C, Maggi L, Gallone A, Kostera-Pruszczyk A, Macias A, Łusakowska A, Nedkova V, Olive M, Álvarez-Velasco R, Wanschitz J, Paradas C, Mavillard F, Querin G, Fernández-Eulate G, Quinlivan R, Walter MC, Depuydt CE, Udd B, Vissing J, Schoser B, Claeys KG. Anoctamin-5 related muscle disease: clinical and genetic findings in a large European cohort. Brain 2023; 146:3800-3815. [PMID: 36913258 DOI: 10.1093/brain/awad088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/06/2023] [Accepted: 02/25/2023] [Indexed: 03/14/2023] Open
Abstract
Anoctamin-5 related muscle disease is caused by biallelic pathogenic variants in the anoctamin-5 gene (ANO5) and shows variable clinical phenotypes: limb-girdle muscular dystrophy type 12 (LGMD-R12), distal muscular dystrophy type 3 (MMD3), pseudometabolic myopathy or asymptomatic hyperCKaemia. In this retrospective, observational, multicentre study we gathered a large European cohort of patients with ANO5-related muscle disease to study the clinical and genetic spectrum and genotype-phenotype correlations. We included 234 patients from 212 different families, contributed by 15 centres from 11 European countries. The largest subgroup was LGMD-R12 (52.6%), followed by pseudometabolic myopathy (20.5%), asymptomatic hyperCKaemia (13.7%) and MMD3 (13.2%). In all subgroups, there was a male predominance, except for pseudometabolic myopathy. Median age at symptom onset of all patients was 33 years (range 23-45 years). The most frequent symptoms at onset were myalgia (35.3%) and exercise intolerance (34.1%), while at last clinical evaluation most frequent symptoms and signs were proximal lower limb weakness (56.9%) and atrophy (38.1%), myalgia (45.1%) and atrophy of the medial gastrocnemius muscle (38.4%). Most patients remained ambulatory (79.4%). At last evaluation, 45.9% of patients with LGMD-R12 additionally had distal weakness in the lower limbs and 48.4% of patients with MMD3 also showed proximal lower limb weakness. Age at symptom onset did not differ significantly between males and females. However, males had a higher risk of using walking aids earlier (P = 0.035). No significant association was identified between sportive versus non-sportive lifestyle before symptom onset and age at symptom onset nor any of the motor outcomes. Cardiac and respiratory involvement that would require treatment occurred very rarely. Ninety-nine different pathogenic variants were identified in ANO5 of which 25 were novel. The most frequent variants were c.191dupA (p.Asn64Lysfs*15) (57.7%) and c.2272C>T (p.Arg758Cys) (11.1%). Patients with two loss-of function variants used walking aids at a significantly earlier age (P = 0.037). Patients homozygous for the c.2272C>T variant showed a later use of walking aids compared to patients with other variants (P = 0.043). We conclude that there was no correlation of the clinical phenotype with the specific genetic variants, and that LGMD-R12 and MMD3 predominantly affect males who have a significantly worse motor outcome. Our study provides useful information for clinical follow up of the patients and for the design of clinical trials with novel therapeutic agents.
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Affiliation(s)
- Alexander de Bruyn
- Department of Neurology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Federica Montagnese
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of Munich, 80336 Munich, Germany
| | - Sonja Holm-Yildiz
- Copenhagen Neuromuscular Center (CNMC), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Nanna Scharff Poulsen
- Copenhagen Neuromuscular Center (CNMC), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Tanya Stojkovic
- Reference Center for Neuromuscular Disorders Nord/Est/Île-de-France, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Anthony Behin
- Reference Center for Neuromuscular Disorders Nord/Est/Île-de-France, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Johanna Palmio
- Neuromuscular Center, Department of Neurology, Tampere University Hospital, 33520 Tampere, Finland
| | - Manu Jokela
- Neuromuscular Center, Department of Neurology, Tampere University Hospital, 33520 Tampere, Finland
- Neurocenter, Department of Neurology, Clinical Neurosciences, Turku University Hospital and University of Turku, 20014 Turku, Finland
| | - Jan L De Bleecker
- Department of Neurology, University Hospital Gent, 9000 Gent, Belgium
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Centers, Location AMC, Neuroscience Institute, University of Amsterdam, 1107 AZ Amsterdam, The Netherlands
| | - Anneke J van der Kooi
- Department of Neurology, Amsterdam University Medical Centers, Location AMC, Neuroscience Institute, University of Amsterdam, 1107 AZ Amsterdam, The Netherlands
| | - Leroy Ten Dam
- Department of Neurology, Amsterdam University Medical Centers, Location AMC, Neuroscience Institute, University of Amsterdam, 1107 AZ Amsterdam, The Netherlands
| | - Cristina Domínguez González
- Reference Center for Rare Neuromuscular Disorders, imas12 Research Institute, Hospital Universitario 12 de Octubre, Biomedical Network Research Center on Rare Diseases (CIBERER), Instituto de Salud Carlos III, 28041 Madrid, Spain
| | - Lorenzo Maggi
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Annamaria Gallone
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | | | - Anna Macias
- Department of Neurology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Anna Łusakowska
- Department of Neurology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Velina Nedkova
- Department of Neurology, Bellvitge Hospital, 08041 Barcelona, Spain
| | - Montse Olive
- Neuromuscular Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau and Biomedical Research Institute Sant Pau (IIB Sat Pau), 08041 Barcelona, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, 28001 Madrid, Spain
| | - Rodrigo Álvarez-Velasco
- Neuromuscular Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau and Biomedical Research Institute Sant Pau (IIB Sat Pau), 08041 Barcelona, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, 28001 Madrid, Spain
| | - Julia Wanschitz
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Carmen Paradas
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Sevilla, Spain
- Centro Investigacion Biomedica en Red Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 41013 Sevilla, Spain
| | - Fabiola Mavillard
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Sevilla, Spain
- Centro Investigacion Biomedica en Red Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 41013 Sevilla, Spain
| | - Giorgia Querin
- Institut de Myologie, I-Motion Adult ClinicalTrials Platform, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Gorka Fernández-Eulate
- Reference Center for Neuromuscular Disorders Nord/Est/Île-de-France, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Ros Quinlivan
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, WC1N 3BG London, UK
| | - Maggie C Walter
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of Munich, 80336 Munich, Germany
| | - Christophe E Depuydt
- Laboratory for Muscle Diseases and Neuropathies, Department of Neurosciences, KU Leuven, and Leuven Brain Institute (LBI), 3000 Leuven, Belgium
| | - Bjarne Udd
- Neuromuscular Center, Department of Neurology, Tampere University Hospital, 33520 Tampere, Finland
| | - John Vissing
- Copenhagen Neuromuscular Center (CNMC), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Benedikt Schoser
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of Munich, 80336 Munich, Germany
| | - Kristl G Claeys
- Department of Neurology, University Hospitals Leuven, 3000 Leuven, Belgium
- Laboratory for Muscle Diseases and Neuropathies, Department of Neurosciences, KU Leuven, and Leuven Brain Institute (LBI), 3000 Leuven, Belgium
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Ito S, Hasebe M, Inoko M. Dramatic recovery of left ventricular dysfunction in a patient with pseudoaldosteronism, hypokalaemia, and rhabdomyolysis: a case report. Eur Heart J Case Rep 2023; 7:ytad398. [PMID: 37662578 PMCID: PMC10473849 DOI: 10.1093/ehjcr/ytad398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/24/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
Background Excessive liquorice ingestion sometimes causes pseudoaldosteronism. The association between liquorice-induced pseudoaldosteronism and acute heart failure has not been well described. Case summary An 89-year-old woman was referred to the hospital due to muscle weakness with rhabdomyolysis and severe hypokalaemia. The electrocardiogram in the emergency department revealed pulseless ventricular tachycardia, thus, emergent defibrillation was delivered. Laboratory findings revealed severe hypokalaemia with metabolic alkalosis. Plasma renin activity and serum aldosterone were highly suppressed. Her medications included herbal medicines containing a great amount of liquorice. The patient was diagnosed with pseudoaldosteronism caused by liquorice over-ingestion. She developed acute pulmonary oedema with unexpected left ventricular (LV) dysfunction after the peak out of creatine kinase. She was managed with acute heart failure therapy, as well as optimal medical therapy. She accidentally developed an acute embolic stroke but fully recovered due to emergent thrombolytic therapy. Cardiac magnetic resonance imaging revealed banding late gadolinium enhancement in the basal-mid segments, which was inconsistent with takotsubo cardiomyopathy. As time passed, LV function unexpectedly improved, and congestive heart failure was completely compensated. Discussion Liquorice contains glycyrrhetinic acid that inhibits 11βHSD2. This invites the over-activation of mineralocorticoid receptors by cortisol in the kidneys and eventually causes hypokalaemia and hypertension. Acute heart failure caused by excessive liquorice ingestion is scarcely described. The triggering factors for LV dysfunction and acute congestive heart failure remain unclear. Rhabdomyolysis could affect massive catecholamine release and cause LV dysfunction.
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Affiliation(s)
- Shinya Ito
- Cardiovascular Center, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka 530-8480, Japan
| | - Masashi Hasebe
- Department of Diabetes and Endocrinology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka 530-8480, Japan
| | - Moriaki Inoko
- Cardiovascular Center, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka 530-8480, Japan
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Amanollahi A, Mehrabi Y, Sedighi M, Basir Ghafouri H, Zahedi A, Shadnia S, Etemad K. Assessment of renal function indexes in methamphetamine or tramadol intoxication adults to the emergency departments: a systematic review and meta-analysis. BMC Emerg Med 2023; 23:89. [PMID: 37568118 PMCID: PMC10416491 DOI: 10.1186/s12873-023-00855-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Renal dysfunction is one of the adverse effects observed in methamphetamine (MET) or tramadol abusers. In this study, we aimed to review articles involving intoxication with MET or tramadol to assess the occurrence of renal dysfunction. METHODS Two researchers systematically searched PubMed, Scopus, Web of Sciences, and Google Scholar databases from 2000 to 2022. All articles that assessed renal function indexes including creatine, Blood Urea Nitrogen (BUN), and Creatine phosphokinase (CPK) in MET and tramadol intoxication at the time of admission in hospitals were included. We applied random effect model with Knapp-Hartung adjustment for meta-analysis using STATA.16 software and reported outcomes with pooled Weighted Mean (WM). RESULTS Pooled WM for BUN was 29.85 (95% CI, 21.25-38.46) in tramadol intoxication and 31.64(95% CI, 12.71-50.57) in MET intoxication. Pooled WM for creatinine in tramadol and MET intoxication was respectively 1.04 (95% CI, 0.84-1.25) and 1.35 (95% CI, 1.13-1.56). Also, pooled WM for CPK was 397.68(376.42-418.94) in tramadol and 909.87(549.98-1269.76) in MET intoxication. No significance was observed in publication bias and heterogeneity tests. CONCLUSION Our findings showed that tramadol or MET intoxication is associated with a considerably increased risk of renal dysfunction that may result in organ failure.
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Affiliation(s)
- Alireza Amanollahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Sedighi
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Basir Ghafouri
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Zahedi
- Department of Environmental Health Engineering, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Shahin Shadnia
- Department of Clinical Toxicology, Toxicological Research Center, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Koorosh Etemad
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Wang Y, Lin Y, Lin Q, Liang H, Cai W, Jiang D. Exploring the association between selective serotonin reuptake inhibitors and rhabdomyolysis risk based on the FDA pharmacovigilance database. Sci Rep 2023; 13:12257. [PMID: 37507539 PMCID: PMC10382477 DOI: 10.1038/s41598-023-39482-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023] Open
Abstract
Rhabdomyolysis is a syndrome potentially fatal and has been associated with selective serotonin reuptake inhibitors (SSRIs) treatment in a few case reports. Herein, we purpose to establish the correlation between SSRIs use and rhabdomyolysis using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. We conducted an analysis on reports that were submitted to the FAERS database during the period between January 1, 2004, and December 31, 2022. Four algorithms, including reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and empirical Bayes geometric mean (EBGM), were employed to quantify the signals of rhabdomyolysis associated with SSRIs. In total, 16,011,277 non-duplicated reports were obtained and analyzed. Among 33,574 reports related to rhabdomyolysis, SSRIs were classified as primary suspected drug in 889 cases. Disproportionality analysis identified a positive signal between rhabdomyolysis and SSRIs (ROR: 2.86, 95% CI 2.67-3.05; PRR: 2.84, χ2: 1037.16; IC0.25 = 1.39; EBGM0.5 = 2.64). Among six SSRIs, fluvoxamine had the strongest signal (ROR: 11.64, 95% CI 8.00-16.93; PRR: 11.38, χ2: 265.51; IC0.25 = 2.41; EBGM0.5 = 8.31), whereas no significant signal of rhabdomyolysis was detected for paroxetine (ROR: 1.83, 95% CI 1.55-2.15; PRR: 1.82, χ2: 53.82; IC0.25 = 0.73; EBGM0.5 = 1.59). After excluding cases co-administered with statins, the signal of rhabdomyolysis associated with SSRIs remains significant. Our analysis reveals that there are differences in safety signals among six SSRIs in respect to the risk of rhabdomyolysis, with fluvoxamine displaying the highest risk signal, while paroxetine did not show a significant signal. Given the potentially lethal nature of rhabdomyolysis, healthcare professionals should inform patients of the potential risk of rhabdomyolysis associated with SSRIs prior to initiating treatment.
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Affiliation(s)
- Yan Wang
- Department of Pharmacy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Yajing Lin
- Department of Pharmacy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Qing Lin
- Department of Pharmacy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Haiming Liang
- Department of Pharmacy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Weiming Cai
- Department of Pharmacy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China.
| | - Dongbo Jiang
- Department of Pharmacy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China.
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Liu P, He M, Xu X, He Y, Yao W, Liu B. Real-world safety of Lacosamide: A pharmacovigilance study based on spontaneous reports in the FDA adverse event reporting system. Seizure 2023; 110:203-211. [PMID: 37423166 DOI: 10.1016/j.seizure.2023.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION Lacosamide is licensed for the treatment of focal seizures in both adults and children, however there is little information available on its adverse reactions. Using the FDA Adverse Event Reporting System (FAERS), we seek to assess adverse occurrences that may be related to Lacosamide. METHODS On the basis of the FAERS database from the fourth quarter of 2008 to the second quarter of 2022, disproportionality analysis was carried out using the reporting odds ratio (ROR) method, the United Kingdom Medicines and Healthcare Products Regulatory Agency omnbius standard (MHRA) method, and the bayesian confidence propagation neural network (BCPNN) method. We extracted valuable positive signals for designated medical event (DME) screening, focused on the evaluation and comparison of safety signals appearing in DME with system organ classification (SOC) analysis. RESULTS A total of 10,226 adverse reaction reports with Lacosamide as the primary suspect drug were obtained, with 30,960 reported cases, detecting 232 valuable positive signals, involving a total of 20 SOCs, of which the most frequently reported SOCs were nervous system disorders (6537 cases, 55.21%), psychiatric disorders (1530 cases, 12.92%), injury poisoning and procedural complications (1059 cases, 8.94%). According to 232 valuable positive signals with DME screening results, two signals of stevens-johnson syndrome and ventricular fibrillation were consistent with PT signals on the DME list, with the two SOCs focusing on skin and subcutaneous tissue disorders and cardiac disorders, respectively. CONCLUSIONS Our research demonstrates that the clinical use of Lacosamide should be noticed and avoided in relation to ADRs since it raises the risk of cardiac arrest, ventricular fibrillation, stevens-johnson syndrome, and rhabdomyolysis.
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Affiliation(s)
- Pengcheng Liu
- China Pharmaceutical University School of International Pharmaceutical Business, Nanjing 211198, Jiangsu, China
| | - Mengjiao He
- China Pharmaceutical University School of International Pharmaceutical Business, Nanjing 211198, Jiangsu, China
| | - Xiaoli Xu
- China Pharmaceutical University School of International Pharmaceutical Business, Nanjing 211198, Jiangsu, China
| | - Yun He
- China Pharmaceutical University School of Science, Nanjing 211198, Jiangsu, China
| | - Wenbing Yao
- China Pharmaceutical University School of International Pharmaceutical Business, Nanjing 211198, Jiangsu, China
| | - Bin Liu
- Department of Neurology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang, China.
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Bicak EA. A first in literature: anesthesia management in kidney transplant surgery of a patient with McArdle disease. Niger J Clin Pract 2023; 26:1045-1049. [PMID: 37635594 DOI: 10.4103/njcp.njcp_895_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
McArdle disease is an inherited myopathy that autosomal recessive inheritance and is also known as glycogen storage disease type 5. Myoglobinuria, increase in serum CK level and darkening of urine color secondary to myoglobinuria are typical. Patients may have symptoms associated with increased rhabdomyolysis secondary acute renal failure or hyperkalemia after long and strenuous exercise periods. Today, many studies in the literature have shown that transplantation is superior to dialysis in patients with end-stage renal disease. Our case is a 53-year-old male patient with the diagnosis of McArdle syndrome who was going to have a kidney transplant. The patient had essential hypertension and history of HBsAg+. Total intravenous anesthesia technique was chosen as the anesthesia technique because inhaled anesthetic agents may trigger malignant hyperthermia in the patient. We didn't experience any perioperative complications in our patient. In conclusion, renal transplantation performed with total intravenous in a McArdle syndrome patient may be a simple and effective technique.
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Affiliation(s)
- E A Bicak
- Department of Anesthesiology and Reanimation, Gazi Yaşargil Training and Research Hospital, Anesthesiology and Reanimation Clinic, Diyarbakir, Turkey
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Santifort KM, Plonek M, Mandigers PJJ. Clinical Diagnosis of Rhabdomyolysis without Myoglobinuria or Electromyographic Abnormalities in a Dog. Animals (Basel) 2023; 13:1747. [PMID: 37889668 PMCID: PMC10251982 DOI: 10.3390/ani13111747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 10/29/2023] Open
Abstract
A 2-year-old female neutered Old German Shepherd was presented for acute non-ambulatory tetraparesis. Upon presentation to the emergency department, hematology and biochemical blood tests revealed no abnormalities aside from mildly elevated C-reactive protein levels (22.5 mg/L, reference range 0.0-10.0) and immeasurable creatine kinase (CK) activity. Neurological evaluation the next day revealed ambulatory tetraparesis, general proprioceptive deficits, mild ataxia and dubious diffuse myalgia. Withdrawal reflexes were weak on both thoracic and pelvic limbs. The CK was determined to be significantly elevated at that point (32.856 U/L, ref. range 10.0-200.0). Urinalysis revealed no abnormalities. An electromyographic (EMG) study of thoracic limb, paraspinal and pelvic limb muscles revealed no abnormalities. A magnetic resonance imaging (MRI) study of the cervicothoracic spinal cord was performed and revealed no abnormalities. A presumptive clinical diagnosis of rhabdomyolysis without myoglobinuria or EMG abnormalities was formed. Muscular biopsies were declined due to the rapid clinical improvement of the dog. A follow-up showed the progressive decline of CK activity to normal values and clinical remission of signs. A diagnosis of rhabdomyolysis was concluded based on clinical signs, consistent CK activity elevations and the response to supportive treatment for rhabdomyolysis, despite the absence of myoglobinuria and EMG abnormalities. Rhabdomyolysis should not be excluded based on the lack of EMG abnormalities or myoglobinuria in dogs.
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Affiliation(s)
- Koen Maurits Santifort
- IVC Evidensia Small Animal Referral Hospital Arnhem, 6825 MB Arnhem, The Netherlands
- IVC Evidensia Small Animal Referral Hospital Hart van Brabant, 5144 AM Waalwijk, The Netherlands
| | - Marta Plonek
- IVC Evidensia Small Animal Referral Hospital Arnhem, 6825 MB Arnhem, The Netherlands
| | - Paul J. J. Mandigers
- IVC Evidensia Small Animal Referral Hospital Arnhem, 6825 MB Arnhem, The Netherlands
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CM Utrecht, The Netherlands
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Al Khaldi T, Gulreez R, Abdelhamid MM, Louri N. Acute carbon monoxide poisoning as a cause of rhabdomyolysis in a case of flame burn. BMJ Case Rep 2023; 16:e236012. [PMID: 37202107 PMCID: PMC10201226 DOI: 10.1136/bcr-2020-236012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 05/20/2023] Open
Abstract
Carbon monoxide (CO) poisoning typically occurs from inhalation of CO at excessive levels. Rhabdomyolsis is not an uncommon complication following acute CO poisoning, yet there are very few reported cases in the literature. It is characterised by rapid breakdown of skeletal muscles and release of its contents into the circulation, leading to acute kidney injury (AKI). Early diagnosis and treatment are crucial to avoid anticipated morbidity and mortality. We are presenting a case of a woman in her 40s with 28% flame burn in a closed space. The patient developed CO poisoning, which led to rhabdomyolysis as evidenced by clinical manifestations and laboratory findings (creatine kinase had reached an unmeasurable level). The patient developed AKI and was successfully managed in our ICU. Here, we are highlighting the importance of considering CO poisoning as one of the potential causes of rhabdomyolysis in burn victim.
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Affiliation(s)
- Turki Al Khaldi
- Plastic Surgery and Burn, Bahrain Defence Force Royal Medical Services, Riffa, Bahrain
| | - Rasheeqa Gulreez
- Plastic Surgery, Bahrain Defence Force Royal Medical Services, Riffa, Bahrain
| | | | - Nayef Louri
- Plastic Surgery, Bahrain Defence Force Royal Medical Services, Riffa, Bahrain
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