Extremely High Creatine Kinase Activity in Rhabdomyolysis without Acute Kidney Injury.

BACKGROUND Elevation of creatine kinase (CK) activity has been shown to be predictive of acute kidney injury (AKI) in rhabdomyolysis. Patients with extremely high CK activity with preserved renal function are uncommon. This report describes a case of non-traumatic rhabdomyolysis, with a markedly elevated CK activity, without associated AKI. CASE REPORT A 22-year-old male presented with severe generalized myalgias and darkened urine for 1 week prior to his admission. The patient presented to the Emergency Department with initial CK activity of >40 000 U/L and a serum creatinine level of 0.77 mg/dL. Urinalysis was positive for myoglobinuria. Serum cystatin C confirmed an estimated glomerular filtration rate of 144 mL/min/1.73 m². Several causes of rhabdomyolysis, including viral infections, Lyme disease, viral hepatitis, hypothyroidism, and cocaine abuse were investigated; however, all were negative. He was given a bolus of 2 liters of normal saline and continued on intravenous normal saline at 250 mL/hour throughout his hospital stay. Urine output remained adequate. We were able to quantify his serum CK activity by dilution method, which revealed a serum CK activity of >150 000 U/L. His CK levels consistently trended down with treatment. CONCLUSIONS An extremely high CK activity in rhabdomyolysis may lead to AKI. However, preserved kidney function is possible. Young age, no concurrent cocaine use, and adequate oral fluid hydration may prevent AKI in rhabdomyolysis. Physicians need to remain vigilant for cases of rhabdomyolysis that have not yet caused renal compromise.

A Rare Case of Cedecea Davisae Bacteremia Presenting as Biliary Sepsis.

Cedecea davisae is a gram-negative, non-sporulating motile rod-shaped bacteria of the Enterobacteriaceae family. It is an opportunistic pathogen in advanced-aged patients with many comorbid diseases and the immunosuppressed. To the best of our knowledge, only 12 cases of C. davisae bacteremia have been reported in the literature. Here we discuss the 13th case of C. davisae bacteremia, which is the first reported case presenting as biliary sepsis. A 41-year-old female, on prednisone for minimal change disease, presented with nausea, vomiting, fever, and diarrhea. She had dry mucous membranes, scleral icterus, and elevated liver enzymes. Blood cultures revealed Cedecea davisae. She improved after management with broad-spectrum antibiotics. Further studies are needed to understand its role in the mode of transmission, the spectrum of infection, and treatment options. There is a need for physicians to be cognizant of emerging pathogens and address their antibiotic resistance profiles.