Subject(s)
Community-Acquired Infections , Confusion , Legionnaires' Disease , Renal Insufficiency , Rhabdomyolysis , Humans , Male , Middle Aged , Brain/diagnostic imaging , Brain/pathology , Confusion/diagnosis , Confusion/etiology , Diagnosis, Differential , Kidney/pathology , Kidney/diagnostic imaging , Renal Insufficiency/diagnosis , Renal Insufficiency/etiology , Tomography, X-Ray Computed , Rhabdomyolysis/diagnosis , Rhabdomyolysis/microbiology , Community-Acquired Infections/complications , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Legionella pneumophila/isolation & purification , Legionnaires' Disease/complications , Legionnaires' Disease/diagnosis , Legionnaires' Disease/microbiologyABSTRACT
INTRODUCTION: We report the case of a 76-year-old male who was hospitalized with severe dehydration, pain in the hepatic region, and weakness in the limbs. METHODOLOGY: A contrast-enhanced abdomen CT and a contrast-enhanced ultrasound identified a large liver abscess. The patient underwent percutaneous drainage of the abscess. RESULTS: The culture examination, analyzed by multiplex polymerase chain reaction test, showed the presence of Klebsiella oxytoca. The laboratory report identified a resistance mechanism involving a plasmid-mediated SHV-1 extended-spectrum-beta-lactamase (ESBL). CONCLUSIONS: K. oxytoca is a Gram-negative bacterium and is potentially associated with a large variety of infections. The association between the liver abscess by K. oxytoca and rhabdomyolysis had not yet been described in the literature.
Subject(s)
Klebsiella Infections , Klebsiella oxytoca , Liver Abscess , Rhabdomyolysis , Ultrasonography , Humans , Male , Klebsiella oxytoca/isolation & purification , Klebsiella oxytoca/genetics , Aged , Rhabdomyolysis/microbiology , Rhabdomyolysis/etiology , Klebsiella Infections/complications , Klebsiella Infections/microbiology , Liver Abscess/microbiology , Tomography, X-Ray Computed , Drainage , beta-Lactamases/genetics , Radiography, Abdominal , Multiplex Polymerase Chain Reaction , Anti-Bacterial Agents/therapeutic useABSTRACT
Human granulocytic anaplasmosis (HGA) is a tick-borne infection caused by Anaplasma phagocytophilum. Only seven cases of HGA have been reported in Japan to date. We report the case of a 61-year-old female farmer who developed HGA with rash and rhabdomyolysis. The patient had fever and erythema covering the entire body, including the palms. An induration with an eschar was observed on the right leg, indicating that the patient had been bitten by a tick. Elevated serum creatinine and creatinine kinase levels and hematuria indicated rhabdomyolysis. We suspected Japanese spotted fever, a tick-borne illness caused by Rickettsia Japonica, and administered minocycline and ciprofloxacin for a week. Transient neutropenia and thrombocytopenia were observed, but the symptoms improved. Polymerase chain reaction (PCR) and antibody tests for R. japonica and Orientia tsutsugamushi, which causes scrub typhus, were both negative. The PCR test for severe fever with thrombocytopenia syndrome virus was also negative. Antibodies against A. phagocytophilum-related proteins were detected by western blotting, indicating seroconversion of IgG with paired serum samples, and the patient was diagnosed with HGA. HGA should be suspected in acute febrile patients with a history of outdoor activity and cytopenia, with or without a rash. A testing system and the accumulation of cases in Japan are necessary for the early diagnosis and appropriate treatment of HGA.
Subject(s)
Anaplasma phagocytophilum , Anaplasmosis , Anti-Bacterial Agents , Exanthema , Rhabdomyolysis , Humans , Female , Middle Aged , Rhabdomyolysis/diagnosis , Rhabdomyolysis/microbiology , Exanthema/microbiology , Exanthema/etiology , Exanthema/diagnosis , Anaplasma phagocytophilum/immunology , Anaplasma phagocytophilum/isolation & purification , Anaplasmosis/diagnosis , Anaplasmosis/complications , Anaplasmosis/drug therapy , Anaplasmosis/microbiology , Anti-Bacterial Agents/therapeutic use , Japan , Ciprofloxacin/therapeutic use , Minocycline/therapeutic useABSTRACT
Anaplasma phagocytophilum (AP) is the causative agent of human granulocytic anaplasmosis (HGA), a tick-borne illness with highest incidence in north-eastern regions of the United States. This condition presents with vague constitutional symptoms and has been associated with laboratory derangements such as leukopenia, thrombocytopenia and transaminitis1. Rhabdomyolysis, however, is not one of these associations. We report a case of confirmed HGA associated with severe rhabdomyolysis, where no other cause was identified. The etiology of rhabdomyolysis secondary to AP infection is still unknown. A presumptive diagnosis of HGA can be made in the presence of fever, non-specific symptoms such as myalgias, laboratory derangements such as leukopenia and thrombocytopenia in an individual residing in an endemic area3. Serological confirmation should not delay treatment, given the rapid progression of this dangerous infection. Rhabdomyolysis should also be considered as part of supporting data in the diagnostic consideration for HGA.
Subject(s)
Anaplasma phagocytophilum/pathogenicity , Anaplasmosis/microbiology , Rhabdomyolysis/microbiology , Adult , Female , Humans , Leukopenia/microbiology , Thrombocytopenia/microbiologyABSTRACT
INTRODUCTION: Myalgia is a classical sign in invasive meningococcal diseases (IMD), but severe and persistent myalgia following an IMD have never been reported to date. CASE REPORT: A 20-year-old man presented with purpura fulminans and meningitis caused by Neisseria meningitidis serogroup Y, revealing properdin deficiency. Although meningitis symptoms improved after antibiotherapy, initial myalgia of the lower limbs increased, associated with mild rhabdomyolysis. Magnetic resonance imaging (MRI) revealed an increased STIR (Short TI inversion recovery) signal of both quadriceps muscles, without abscess. After exclusion of other causes of myopathy, a post-infectious myositis was diagnosed. A four-week course of corticosteroids led to dramatic improvement. CONCLUSION: Post-infectious inflammatory myopathy should be suspected in case of severe and persistent myalgia associated with rhabdomyolysis following an IMD, after exclusion of pyomyositis especially. A short course of corticosteroids seems to be effective.
Subject(s)
Meningitis, Meningococcal/complications , Myalgia/microbiology , Myositis/microbiology , Properdin/deficiency , Rhabdomyolysis/microbiology , Humans , Male , Neisseria meningitidis , Purpura Fulminans/complications , Young AdultABSTRACT
Legionnaires' disease is a recognised but rare cause of rhabdomyolysis. It can be further complicated with renal impairment. In this case report, we describe a previously healthy, semiactive 50-year-old man who within days was reduced to having periods of dyspnea after minutes of walking in addition to near fatal acute renal failure. He was found to have the rare triad of Legionella pneumonia, renal failure and rhabdomyolysis, which is associated with high morbidity and mortality. He was treated according to guidelines with azithromycin monotherapy and aggressive fluid hydration. 20 days after admission, the patient was walking independently and discharged home.
Subject(s)
Legionnaires' Disease/complications , Pneumonia/complications , Rhabdomyolysis/etiology , Acute Kidney Injury/etiology , Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , Diagnosis, Differential , Humans , Legionella pneumophila/isolation & purification , Legionnaires' Disease/diagnosis , Legionnaires' Disease/drug therapy , Legionnaires' Disease/microbiology , Male , Middle Aged , Pneumonia/diagnosis , Pneumonia/microbiology , Rhabdomyolysis/microbiology , Rhabdomyolysis/pathology , Treatment OutcomeSubject(s)
Acute Kidney Injury/microbiology , Clostridium Infections/complications , Myoglobinuria/microbiology , Acute Kidney Injury/enzymology , Chronic Disease , Clostridioides difficile , Diarrhea/microbiology , Humans , Liver Diseases/complications , Male , Middle Aged , Rhabdomyolysis/microbiologySubject(s)
Bacteremia/complications , Enterobacter/isolation & purification , Rhabdomyolysis/microbiology , Rosa/microbiology , Skin/injuries , Anti-Bacterial Agents/therapeutic use , Bacteremia/diagnosis , Bacteremia/drug therapy , Bacteremia/microbiology , Cefazolin/therapeutic use , Foot , Humans , Male , Middle Aged , Rhabdomyolysis/diagnosis , Rhabdomyolysis/drug therapy , Skin/microbiologySubject(s)
Acute Kidney Injury/etiology , Anti-Bacterial Agents/therapeutic use , Leptospira interrogans serovar icterohaemorrhagiae/isolation & purification , Rhabdomyolysis/microbiology , Weil Disease/diagnosis , Acute Kidney Injury/blood , Acute Kidney Injury/therapy , Acute Kidney Injury/urine , Adolescent , Agglutination Tests , Diagnosis, Differential , Diarrhea/etiology , Fluid Therapy , Hemolytic-Uremic Syndrome/diagnosis , Hepatomegaly/etiology , Humans , Jaundice/etiology , Male , Myalgia/etiology , Oliguria/etiology , Rhabdomyolysis/blood , Rhabdomyolysis/therapy , Rhabdomyolysis/urine , Vomiting/etiology , Weil Disease/complications , Weil Disease/microbiologyABSTRACT
Rhabdomyolysis is a very rare and serious extrapulmonary manifestation of a Mycoplasma pneumoniae infection. We describe a case of a 47-year-old male patient who presented with progressive dyspnoea, hypoxaemia and cough during the last 3 days. He had no relevant muscular complaints but was diagnosed with severe rhabdomyolysis for which he was treated with hyperhydration. Molecular diagnostics confirmed M. pneumoniae as the causative agent and our patient was successfully treated with doxycycline.Only a few cases of rhabdomyolysis complicating a M. pneumoniae infection have been described, mostly in infants. In this case, typical suggestive complaints of rhabdomyolysis were absent suggesting that the complication might be underdiagnosed.
Subject(s)
Pneumonia, Mycoplasma/complications , Rhabdomyolysis/microbiology , Anti-Bacterial Agents/therapeutic use , Doxycycline/therapeutic use , Humans , Male , Middle Aged , Mycoplasma pneumoniae/isolation & purification , Pneumonia, Mycoplasma/drug therapy , Treatment OutcomeABSTRACT
Acute kidney injury (AKI) from leptospirosis is frequently nonoliguric with hypo- or normokalemia. Higher serum potassium levels are observed in non-survivor patients and may have been caused by more severe AKI, metabolic disarrangement, or rhabdomyolysis. An association between the creatine phosphokinase (CPK) level and maximum serum creatinine level has been observed in these patients, which suggests that rhabdomyolysis contributes to severe AKI and hyperkalemia. LipL32 and Lp25 are conserved proteins in pathogenic strains of Leptospira spp., but these proteins have no known function. This study evaluated the effect of these proteins on renal function in guinea pigs. Lp25 is an outer membrane protein that appears responsible for the development of oliguric AKI associated with hyperkalemia induced by rhabdomyolysis (e.g., elevated CPK, uric acid and serum phosphate). This study is the first characterization of a leptospiral outer membrane protein that is associated with severe manifestations of leptospirosis. Therapeutic methods to attenuate this protein and inhibit rhabdomyolysis-induced AKI could protect animals and patients from severe forms of this disease and decrease mortality.
Subject(s)
Acute Kidney Injury/pathology , Bacterial Outer Membrane Proteins/metabolism , Leptospirosis/complications , Lipoproteins/metabolism , Rhabdomyolysis/pathology , Acute Kidney Injury/microbiology , Animals , Creatine Kinase/blood , Creatinine/blood , Disease Models, Animal , Guinea Pigs , Leptospira , Muscles/pathology , Potassium/blood , Rhabdomyolysis/microbiologyABSTRACT
Typhoid fever is an important cause of morbidity and mortality in the developing world, particularly in children, but is infrequently observed in the developed world and can occur in patients without a significant travel history. Rhabdomyolysis as a complication has rarely been reported, and never in a child. A child with Salmonella enterica serovar Typhi septicemia, complicated by rhabdomyolysis, encephalopathy and pancreatitis is described and all 15 reported cases to date are summarized.
Subject(s)
Rhabdomyolysis , Typhoid Fever , Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , Child , Female , Humans , Rhabdomyolysis/drug therapy , Rhabdomyolysis/etiology , Rhabdomyolysis/microbiology , Typhoid Fever/complications , Typhoid Fever/drug therapy , Typhoid Fever/microbiologyABSTRACT
RATIONALE: Rhabdomyolysis is a well-known syndrome in clinical practice, although rhabdomyolysis caused by a liver abscess is rarely reported and the patient may lack symptoms that are associated with a primary site of infection. Early recognition of this possibility is needed to avoid diagnostic delay and facilitate treatment. We report the case of a 71-year-old woman with a Klebsiella pneumoniae (KP) pyogenic liver abscess who presented with myasthenia and tea-colored urine and also review the 77 reported cases of bacterial rhabdomyolysis. PATIENT CONCERNS: The patient was 71 years old and presenting with a 7-day history of myasthenia and a 3-day history of tea-colored urine, but without fever or abdominal pain. DIAGNOSES: Laboratory testing in our case revealed rhabdomyolysis, and blood culture revealed KP. Abdominal ultrasonography revealed a hypoechoic enclosed mass, and computed tomography (CT) revealed an enclosed low-density mass (8.3â×â6.6â×â6.1âcm). The main diagnoses were a pyogenic liver abscess with rhabdomyolysis. INTERVENTIONS: Empirically intravenous piperacillin-sulbactam and intravenous potassium treatment, as well as fluid infusions and other supportive treatments were provided after admission. After the diagnosis was confirmed and susceptibility test results were available, we adjusted the antibiotics to cefoperazone and sulbactam, which were maintained for 6 weeks. OUTCOMES: The patient's symptoms relieved and the abnormal laboratory parameters corrected. Follow-up abdominal ultrasonography at 24 months after her discharge revealed that the abscess had disappeared. LESSONS: Early recognition and careful consideration of the underlying cause of rhabdomyolysis are critical to improving the patient's prognosis. Thus, physicians should carefully consider the underlying cause in elderly patients who present with rhabdomyolysis, as they may lack symptoms of a primary infection.
Subject(s)
Klebsiella Infections/diagnosis , Klebsiella pneumoniae , Liver Abscess/diagnosis , Muscle Weakness/etiology , Rhabdomyolysis/etiology , Aged , Humans , Klebsiella Infections/complications , Klebsiella Infections/pathology , Klebsiella Infections/urine , Liver Abscess/complications , Liver Abscess/pathology , Liver Abscess/urine , Muscle Weakness/microbiology , Muscle Weakness/urine , Rhabdomyolysis/microbiology , Rhabdomyolysis/urineABSTRACT
Legionnaires' disease is a bacterial disease of the respiratory system caused by a gram-negative germ whose clinical manifestation can be benign limiting to flu-like syndrome or can be more severe being characterized by pneumonia which may be complicated by multisystem disease that can lead to death. We report the case of a 48 year-old patient with rhabdomyolysis complicated by acute renal failure following Legionella pneumophila pneumonia. We here highlight the pathophysiological aspects and treatment of this rare complication during Legionella infection.
Subject(s)
Acute Kidney Injury/etiology , Legionnaires' Disease/complications , Pneumonia, Bacterial/complications , Rhabdomyolysis/etiology , Humans , Legionella pneumophila/isolation & purification , Legionnaires' Disease/microbiology , Male , Middle Aged , Pneumonia, Bacterial/microbiology , Rhabdomyolysis/complications , Rhabdomyolysis/microbiologySubject(s)
Acute Kidney Injury/microbiology , Myositis/microbiology , Rhabdomyolysis/microbiology , Syphilis/microbiology , Treponema pallidum/isolation & purification , Acute Kidney Injury/diagnosis , Acute Kidney Injury/therapy , Administration, Intravenous , Anti-Bacterial Agents/administration & dosage , Female , Humans , Myositis/diagnosis , Myositis/therapy , Penicillin G/administration & dosage , Renal Dialysis , Rhabdomyolysis/diagnosis , Rhabdomyolysis/therapy , Syphilis/complications , Syphilis/diagnosis , Syphilis/therapy , Treatment Outcome , Young AdultABSTRACT
Rhabdomyolysis is characterized by a marked elevation of the creatine kinase (CK) levels and myoglobinuria, thus leading to renal dysfunction. Various viruses or bacteria can be etiologic agents, but mycosis has only rarely been reported to be a cause of rhabdomyolysis. In this report, we describe an adolescent male with acute myeloid leukemia who underwent allogeneic bone marrow transplantation and thereafter developed rhabdomyolysis and Candida parapsilosis fungemia almost at the same time. Following treatment for C. parapsilosis, the transaminase and CK levels both satisfactorily decreased. This case illustrates that C. parapsilosis infection may be a causative agent of rhabdomyolysis in immunocompromised patients.
Subject(s)
Antifungal Agents/administration & dosage , Bone Marrow Transplantation/adverse effects , Candida/isolation & purification , Fungemia/microbiology , Leukemia, Myeloid, Acute/therapy , Rhabdomyolysis/diagnosis , Rhabdomyolysis/etiology , Adult , Candida/classification , Humans , Immunocompromised Host , Leukemia, Myeloid, Acute/blood , Leukemia, Myeloid, Acute/complications , Male , Microbial Sensitivity Tests , Remission Induction , Rhabdomyolysis/drug therapy , Rhabdomyolysis/microbiologyABSTRACT
Wild mushroom poisoning is often reported to cause acute liver or renal failure. However, acute rhabdomyolysis caused by wild mushroom poisoning has rarely been reported. We describe 7 patients of 1 family with Russula subnigricans Hongo poisoning. Their clinical manifestations varied from gastrointestinal symptoms to rhabdomyolysis, with 1 fatality. Our report provides supporting evidence that rhabdomyolysis may result from ingestion of R subnigricans mushrooms. A key to survival for patients with rhabdomyolysis caused by R subnigricans poisoning may be early recognition and intensive supportive care.
Subject(s)
Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/therapy , Mushroom Poisoning/diagnosis , Mushroom Poisoning/therapy , Rhabdomyolysis/diagnosis , Rhabdomyolysis/therapy , Adolescent , Adult , Basidiomycota/physiology , China , Fatal Outcome , Female , Gastrointestinal Diseases/microbiology , Gastrointestinal Diseases/physiopathology , Humans , Male , Middle Aged , Mushroom Poisoning/microbiology , Mushroom Poisoning/physiopathology , Rhabdomyolysis/microbiology , Rhabdomyolysis/physiopathology , Treatment Outcome , Young AdultABSTRACT
UNLABELLED: We report on a 5-year-old boy with recurrent severe postinfectious rhabdomyolysis who, after systematic stepwise evaluation, was found to have the adult form of carnitine palmityl transferase II (CPT II) deficiency directly by blood mutation analysis. Timely diagnosis of CPT II deficiency in this case prevented further potentially devastating episodes of rhabdomyolysis by avoiding triggering factors. CONCLUSION: Although most cases of rhabdomyolysis are nonrecurrent and benign, a metabolic myopathy, such as CPT II deficiency, should be suspected in children with episodic muscle necrosis and paroxysmal myoglobinuria.
Subject(s)
Carnitine O-Palmitoyltransferase/deficiency , Lipid Metabolism, Inborn Errors/diagnosis , Mitochondrial Diseases/diagnosis , Muscular Diseases/diagnosis , Rhabdomyolysis/diagnosis , Carnitine O-Palmitoyltransferase/genetics , Child, Preschool , DNA Mutational Analysis , Humans , Male , Mutation , Rhabdomyolysis/microbiologyABSTRACT
Mediterranean spotted fever (MSF) is a tick-borne zoonosis caused by Rickettsia conorii. In Italy, about 400 cases are reported every year and nearly half of them occur in Sicily, which is one of the most endemic regions. Although MSF is mostly a self-limited disease characterized by fever, skin rash, and a dark eschar at the site of the tick bite called a 'tache noire', serious complications are described, mainly in adult patients. Nevertheless, severe forms of the disease with major morbidity and a higher mortality risk have been described. We report a fatal case of MSF complicated by rhabdomyolysis, acute renal failure, and encephalitis in an elderly woman.
Subject(s)
Acute Kidney Injury/microbiology , Boutonneuse Fever/complications , Encephalitis/microbiology , Rhabdomyolysis/microbiology , Acute Kidney Injury/diagnosis , Aged , Boutonneuse Fever/diagnosis , Encephalitis/diagnosis , Female , Humans , Rhabdomyolysis/diagnosisABSTRACT
We report the emergence of OXA-48 carbapenemase-producing Escherichia coli in Austria causing ventilator-associated pneumonia in a traveler returning from Egypt. Depending on resistance testing, quinolones may remain a therapeutic option for infections caused by these multiple resistant pathogens, as this class of drugs has a favorable safety and tolerability profile when compared to the alternatives. In this patient, however, the clinical course was dramatically complicated by the development of ciprofloxacin-associated rhabdomyolysis.