A Common Drug With a Dangerous Side Effect: Acute Rhabdomyolysis Caused by the Synergistic Effect of Isotretinoin and Exercise in an Adolescent

Rhabdomyolysis Caused by Isotretinoin and Exercise in an Otherwise Healthy Female Patient

Acne vulgaris is one of the most common skin conditions treated by healthcare providers. Isotretinoin is a well-known and effective treatment for nodulocystic and scarring acne. Rarely, and usually in combination with exercise, patients treated with isotretinoin can develop rhabdomyolysis, a potentially life-threatening breakdown of muscle associated with elevated creatine kinase (CK). Here, we report a rare case of a female patient developing rhabdomyolysis three months after starting exercise and isotretinoin. She was treated with supportive care and medication was discontinued, resulting in a full recovery. Careful inquiry into the patient's exercise habits, along with a thorough review of systems at each visit can help identify high-risk patients. Routine monitoring of liver enzymes, specifically aspartate aminotransferase elevations, may provide a prompt to check a patient’s CK. Though regular monitoring of CK is not currently recommended, given the prevalence of regular exercise in certain patient populations, this case reinforces the importance of counseling patients on this potential side effect.

Hypothyroidism Induced Rhabdomyolysis in a Young Male after a Single Intramuscular Injection: A Case Report

Hypothyroidism is a common endocrine disorder resulting from the inability of the thyroid gland to produce sufficient thyroid hormone for the metabolic demands of the body. Clinical symptoms and signs are often non-specific and subtle. Muscular symptoms are frequently reported. Rhabdomyolysis is a life-threatening condition caused by necrosis of muscles and leakage of toxic intracellular components into the blood circulation. Hypothyroidism induced rhabdomyolysis, represents an unusual clinical occurrence. This is a case of a middle-aged man, who presented with severe myalgias, following an intramuscular injection. After laboratory work-up, he was diagnosed with rhabdomyolysis. Laboratory and ultrasound tests disclosed primary hypothyroidism of auto-immune etiology.