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.

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.

Rhabdomyolysis and Pigment Nephropathy - An Uncommon Manifestation of Eucalyptus Oil Consumption.

Eucalyptus oil consumption is well known to cause adverse effects on central nervous system like seizures, ataxia and unconsciousness. No antidote is available and treatment is largely supportive. We report a case of rhabdomyolysis with pigment cast nephropathy and acute kidney injury in a young female following eucalyptus oil consumption and its successful management.

A Neuropathy Mimic: Statin-Induced Myopathy Presenting as Guillain-Barré Syndrome.

Statins are widely used to manage dyslipidemia and prevent cardiovascular diseases due to their effectiveness and general safety profile. However, they can sometimes cause severe muscle-related adverse effects, presenting diagnostic challenges when symptoms overlap with other conditions. This case report describes a middle-aged woman who presented to the emergency department with bilateral lower limb weakness, initially suggesting Guillain-Barré syndrome (GBS). Despite her history of low-grade fever and diarrhea, primary and secondary surveys, including electrocardiogram, blood gas analysis, and nerve conduction studies, showed no definitive signs of GBS. The patient had a recent history of percutaneous transluminal coronary angioplasty and was on dual antiplatelet therapy and rosuvastatin. Elevated creatine kinase levels and exclusion of other differential diagnoses led to the diagnosis of statin-induced myopathy, a rare but severe adverse effect of statins. The patient was treated with intravenous fluids, cessation of statins, and sessions of hemodialysis and plasmapheresis, resulting in significant improvement and eventual recovery of muscle power and neurological function. This case highlights the importance of recognizing statin-induced myopathy in patients with muscle weakness and emphasizes the need for thorough clinical evaluation to differentiate it from other conditions such as GBS. Further research is warranted to understand the pathophysiology of statin myopathy and identify at-risk populations.

MDMA("Ecstasy") abuse leading to delayed onset rhabdomyolysis: A case report and literature review.

MDMA and cocaine can result in acute onset rhabdomyolysis. However, delayed onset rhabdomyolysis and its pathophysiology is of concern Early therapeutic intervention improves prognosis. Such cases should be promptly referred and managed in centers equipped with critical care and renal replacement therapy.

An acute life-threatening episode of rhabdomyolysis, renal failure, altered mental status and hyperammonemia in an adult with 3-methylcrotonyl-CoA carboxylase deficiency.

3-methylcrotonyl-CoA carboxylase (3-MCC) deficiency is an autosomal recessive disorder of leucine metabolism. Since 3-MCC deficiency is thought to be a benign condition, a few newborn screening programs discontinued to screen this condition. We report a case of a 24-year-old previously healthy male patient who developed generalized rhabdomyolysis, weakness, respiratory and renal failure, acute pancreatitis, hyperammonemia, and altered consciousness after strenuous exercise. Diagnosis of 3-MCC was made based on increased plasma C5OH carnitine, urine 3-methylcrotonylglycine, and 3-hydroxyisovalerate, and later whole genome sequencing study confirmed the diagnosis. Low plasma carnitine and high creatine kinase (CK) levels were again noted after two months of poor compliance with carnitine therapy. Since 3-MCC deficiency is often incidentally diagnosed in asymptomatic mothers through positive newborn screening in the newborns and most positive newborn screening cases have benign clinical outcomes, 3-MCC deficiency has been considered a benign condition. Observation of a life-threatening episode triggered by strenuous exercise and recurrent occurrence of low carnitine and high CK without carnitine supplementation may support 3-MCC deficiency to be the condition covered by the newborn screen since carnitine supplementation likely prevents an episode that can be life-threatening. Asymptomatic adults with 3-MCC deficiency may benefit from periodic evaluation of plasma carnitine levels.

Osimertinib-Induced Myositis in a Patient With Metastatic Non-small Cell Lung Cancer With Epidermal Growth Factor Receptor Mutation.

Osimertinib is a third-generation tyrosine kinase inhibitor (TKI) that has emerged as a standard treatment in non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation. While it is generally well tolerated, milder side effects of diarrhea, cytopenia, and cutaneous rashes are common. Osimertinib-induced myositis and rhabdomyolysis are exceedingly rare, and only a few cases have been documented in the literature to date. In this report, we present a case of a 59-year-old female with metastatic NSCLC who experienced myalgia following the initiation of osimertinib. Blood work revealed elevated creatine kinase (CK), serum creatinine (Cr), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Initially, her myalgia improved, and lab work normalized after drug discontinuation and supportive care. However, rechallenge with a 50% dose resulted in recurrence of symptoms and elevated serum CK, Cr, ALT, and AST. MRI findings suggested diffuse inflammation and a muscle biopsy revealed necrotizing myopathy. Symptoms ameliorated upon complete cessation of the drug and use of steroids. This case highlights the importance of recognizing this rare adverse effect of osimertinib and a guide for managing these associated symptoms.

Myopathy in Statin-Treated Children and Adolescents: A Practical Approach.

PURPOSE OF REVIEW: This paper reviews the existing literature on statin-related myopathy in children and adolescents, to inform development of a practical management approach. RECENT FINDINGS: Reports of statin treatment in the pediatric population revealed no evidence of muscle pathology, with asymptomatic elevation of creatine kinase(CK) levels and symptoms of muscle pain without CK elevation seen equally in subjects and controls in RCTs. By contrast, rare cases of rhabdomyolysis have now been documented in statin-treated children; this serious problem had never been previously reported. Statin-induced myopathy is rare in childhood so routine monitoring of CK levels is unnecessary in asymptomatic patients, reserved for those with muscle pain. Rare case reports of rhabdomyolysis in statin-treated children and adolescents suggest that parent and patient education on symptoms of adverse statin effects should include immediate physician contact with the appearance of dark urine, with or without muscle pain.

Contribution of medical resonance imaging in the return to physical activity after exertional rhabdomyolysis a case report.

INTRODUCTION: Exertional rhabdomyolysis (ER) is the breakdown of muscle cells that occurs after intensive physical activity. Although a cautious and gradual return to physical activity (RTPA) is recommended after an episode of ER, physical sequelae are reported long afterwards. CASE REPORT: We present the case of a 31-year-old untrained amateur runner with no prior medical history who developed heat stroke, ER, and acute kidney failure on the occasion of a half-marathon. Three months later, whereas the patient was symptom-free and CK levels were normal, an MRI revealed typical signs of rhabdomyolysis, which normalized thereafter. DISCUSSION: Given that clinical and biological data inform RTPA decisions, the delay between clinical biological and MRI normalization may cause an RTPA to be initiated prior to full muscle recovery, which could account for the symptoms' prolonged persistence. In sportspeople who have recovered and their CK blood levels are returned to normal, MRI data could defer the RTPA if MRI abnormalities persist or, conversely, give it the green light.

In the event of exertional rhabdomyolysis following a race, the presence of muscular lesions on MRI, even if the patient feels healed and creatine kinase levels have returned to normal, should postpone the return to physical activity.

Rhabdomyolysis presenting with septic shock in a 21 year old female patient: A case report.

Rhabdomyolysis is a clinical condition characterized by the release of intracellular content into the bloodstream, resulting in the breakdown of skeletal muscle. The released intracellular content includes electrolytes, enzymes, and myoglobin, leading to systemic complications. The clinical presentation may vary, ranging from an asymptomatic increase in serum levels of enzymes released from damaged muscles to worrisome conditions such as volume depletion, metabolic and electrolyte abnormalities, and acute kidney injury. The diagnosis is confirmed when the serum creatine kinase (CK) level is > 1000 U/L or at least 5x the upper limit of normal. In this study, we aimed to evaluate a 21-year-old female patient presenting with nontraumatic exercise-unrelated rhabdomyolysis, accompanied by acute renal failure and septic shock.

[Effect of Plasmafiltration and Adsorption in Cocaine Abuse: A Case Report].

Rhabdomyolysis is one of the principal causes of acute kidney disease. Multiple endogenous and exogenous causes could start this process: cocaine addiction, a social phenomenon present in our Country among young adults, is one exogenous causes. Natural stimulating alkaloid cocaine has toxic action on multiple systems, principally central nervous system and cardiovascular system. Etiopathogenesis is related either to changes in local and systemic hemodynamics, or to direct damage caused by myofibril accumulation, or to immunological events leading to vasculitis or thrombotic microangiopathies. Scientific evidences describe different therapeutic approaches: supportive therapy, extracorporeal treatments and possible removal of the pathogenic noxa, and the therapeutic apheresis plays a role yet to be confirmed in this field. We describe the case of a 52-year-old man, hospitalized in the Cardiological Intensive Care Unit of our hospital, due to serious alterations in the indices of myocardiocytonecrosis and liver function, following cocaine abuse. During hospitalization, renal function indices worsened associated to diuresis contraction and onset of metabolic acidosis, not responsive to medical therapy. Also in consideration of myoglobin high circulating levels, related to rhabdomyolysis, the patient went under a cycle of selective apheresis using adsorption with a TR350 cartridge associated to hemodialysis: after two adsorption sessions, the patient resumed spontaneous diuresis with progressive normalization of the blood indices.

Multiple site inflammation and acute kidney injury in crush syndrome.

Crush syndrome, which frequently occurs in earthquake disasters, often leads to rhabdomyolysis induced acute kidney injury (RIAKI). Recent findings indicate that systemic inflammatory response syndrome (SIRS) exacerbates muscle collapse, contributing to RIAKI. The purpose of this study is to investigate the involvement of multiple site inflammation, including intraperitoneal, in crush syndrome. In a mouse model of RIAKI, elevated levels of inflammatory mediators such as TNFα, IL-6, myoglobin, and dsDNA were observed in serum and the peritoneal cavity, peaking earlier in the intraperitoneal cavity than in serum or urine. Our previously developed novel peptide inhibiting leukocyte extracellular traps was administered intraperitoneally and blocked all of these mediators in the intraperitoneal cavity and serum, ameliorating muscle damage and consequent RIAKI. Although further studies are needed to determine whether intraperitoneal inflammation associated with muscle collapse can lead to systemic inflammation, resulting in more severe and prolonged muscle damage and renal injury, early suppression of multiple site inflammation, including intraperitoneal, might be an effective therapeutic target.

Polymyositis and Severe Rhabdomyolysis in the Context of Influenza and COVID-19 Vaccination: A Case Report.

Rhabdomyolysis is characterized by muscle breakdown and the release of muscle enzymes into the bloodstream, which can lead to acute kidney injury (AKI) and electrolyte imbalances. This case report details a 52-year-old male who developed severe rhabdomyolysis and polymyositis following influenza and SARS-COV-2 vaccinations. Presenting with severe muscle pain and elevated creatine kinase (CK) levels, the patient's condition was managed with aggressive hydration and supportive care, resulting in significant recovery. While vaccine-related adverse effects such as myositis and rhabdomyolysis are rare, this case underscores the need for vigilance in monitoring post-vaccination complications and highlights the importance of recognizing and promptly treating vaccine-associated inflammatory myopathies to prevent severe complications. The findings contribute to the growing body of literature on vaccine-induced myopathies and emphasize the necessity of a multidisciplinary approach in managing such complex cases.

Unraveling Complexity: Acute Intermittent Porphyria Complicated by Rhabdomyolysis and Acute Pancreatitis.

Acute intermittent porphyria (AIP) is a rare autosomal dominant disorder characterized by defective porphyrin metabolism in the blood. It manifests through variable clinical features, among these are abdominal pain, nausea, vomiting, peripheral neuropathy, and seizure. The diverse presentation of AIP poses substantial diagnostic challenges due to its potential to mimic other medical conditions, delaying early recognition and intervention. Management strategies of AIP involve a multifaceted approach, focusing on symptom relief and attack cessation. Early recognition and intervention are pivotal in optimizing patient outcomes, highlighting the importance of heightened clinical suspicion and precise diagnostic pathways. We present a unique case of a 34-year-old female who presented to the emergency department with severe abdominal pain, oliguria, and progressive sensory and motor deficits. Despite exhibiting hallmark symptoms suggestive of AIP, the absence of distinctive "attack periods" added complexity to the diagnostic process, requiring the exclusion of other medical conditions with similar overlapping symptoms.

Complexities of Severe Leptospirosis: A Case With Acute Hypoxic Respiratory Failure, Acute Kidney Injury, and Hyponatremia.

Leptospirosis, an acute zoonotic infection caused by spirochetes of the genus Leptospira, poses significant health risks worldwide. Transmission occurs through contact with infected animals' urine, blood, or tissue. This case report examines a 44-year-old man with severe leptospirosis, presenting as Weil's disease, characterized by acute hypoxic respiratory failure and acute kidney injury (AKI) secondary to rhabdomyolysis, complicated by severe hyponatremia. The case underscores the diagnostic and management challenges associated with leptospirosis, highlighting the importance of interdisciplinary collaboration and comprehensive diagnostic evaluation.

Rosuvastatin-Induced Rhabdomyolysis as a Result of Drug Interaction With Sitagliptin: A Case Report.

Rhabdomyolysis was not reported in clinical trials with Sitagliptin alone. However, several reports in the literature on rhabdomyolysis resulted from the interaction between statins and Sitagliptin. In patients with type 2 diabetes and hyperlipidemia, it is expected to co-prescribe statins and Sitagliptin. Herein, we report the case of a 64-year-old woman with rhabdomyolysis should be caused by a drug-drug interaction between Rosuvastatin and Sitagliptin. The patient denied any history of weakness or myalgia during past medical assessments.

Slowly Progressive Rhabdomyolysis Post COVID-19: Insights for Acute Kidney Injury Prediction With Discordant Creatine Kinase and Myoglobin Elevations.

Rhabdomyolysis can lead to acute kidney injury (AKI), primarily due to myoglobin-induced tubular damage. We present a case of slowly progressive rhabdomyolysis following SARS-CoV-2 infection in a 28-year-old male who was monitored through serial serum creatine kinase (CK) and myoglobin levels. Despite prominent CK elevations, the patient did not develop AKI, probably due to disproportionately mild serum myoglobin elevation with distinctive cyclic spikes. This case underscores the informative value of frequent monitoring of both CK and myoglobin to assess muscle damage severity and AKI risk in rhabdomyolysis, particularly with viral infections like COVID-19 that can cause delayed-onset muscle injury.

Asymptomatic COVID-19 Infection-Induced Rhabdomyolysis in the Backdrop of Statin-Cyclosporine Drug Interaction.

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.

Statins in the Cause and Prevention of Cancer: Confounding by Indication and Mediation by Rhabdomyolysis and Phosphate Toxicity.

Statins are drugs used in cardiovascular pharmacotherapy to decrease hypercholesterolemia and lower the risk of atherosclerosis. Statins also increase the risk of rhabdomyolysis, which is often minimized in comparison with large relative risk reductions of cardiovascular disease reported in clinical trials. By contrast, absolute risk reductions of cardiovascular disease are often clinically insignificant and unreported in statin clinical trials. Additionally, cytotoxic effects of statins inhibit cancer cell proliferation and reduce cancer risk, but other studies found that statins are carcinogenic. Due to an inverse association between incidence of cancer and atherosclerosis, the indication to prescribe statins likely biases the association of statins with cancer prevention. Dietary patterns associated with atherosclerosis and cancer contain inverse amounts of cholesterol and phosphate, an essential mineral that stimulates tumorigenesis. Accordingly, lower cancer risk is associated with high dietary cholesterol intake and increased risk of atherosclerosis. Furthermore, serum is exposed to excessive inorganic phosphate that could increase cancer risk as rhabdomyolysis induced by statins releases phosphate from skeletal muscle breakdown. Increased risk of comorbid conditions associated with statins may share the mediating factor of phosphate toxicity. More research is warranted on statins in the cause and prevention of cancer.