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1.
BMC Infect Dis ; 21(1): 522, 2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34082705

RESUMO

BACKGROUND: Leptospirosis is a zoonotic spirochetal disease caused by Leptospira interrogans. The clinical presentation ranges from an asymptomatic state to a fatal multiorgan dysfunction. Neurological manifestations including aseptic meningitis, spinal cord and peripheral nerve involvement, cranial neuropathies and cerebellar syndrome are well recognized with varying frequencies among patients with this disease. Posterior reversible encephalopathy syndrome is a very rare occurrence in leptospirosis and only two cases are reported in the medical literature up to now. We report a case of posterior reversible encephalopathy syndrome in a patient with leptospirosis with rhabdomyolysis and acute kidney injury. CASE PRESENTATION: A 21 year-old male presented with fever and oliguric acute kidney injury with rhabdomyolysis. A diagnosis of leptospirosis was made and he was being managed according to the standard practice together with regular hemodialysis. The clinical condition was improving gradually. On day 8 of the illness, he developed headache and sudden painless complete bilateral vision loss followed by several brief generalized tonic clonic seizure attacks. Examination was significant for a Glasgow Coma Scale of 14/15, blood pressure of 150/90 mmHg and complete bilateral blindness. The findings of magnetic resonance imaging of the brain were compatible with posterior reversible encephalopathy syndrome. He was managed with blood pressure control and antiepileptics with supportive measures and standard treatment for leptospirosis and made a complete recovery. CONCLUSION: Posterior reversible encephalopathy syndrome, though very rare with leptospirosis, should be considered as a differential diagnosis in a patient with new onset visual symptoms and seizures, especially during the immune phase. Optimal supportive care together with careful blood pressure control and seizure management would yield a favourable outcome in this reversible entity.


Assuntos
Injúria Renal Aguda/complicações , Leptospirose/complicações , Síndrome da Leucoencefalopatia Posterior/etiologia , Rabdomiólise/complicações , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/fisiopatologia , Injúria Renal Aguda/terapia , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Leptospirose/diagnóstico , Leptospirose/fisiopatologia , Leptospirose/terapia , Imageamento por Ressonância Magnética , Masculino , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Síndrome da Leucoencefalopatia Posterior/terapia , Rabdomiólise/diagnóstico , Rabdomiólise/fisiopatologia , Rabdomiólise/terapia , Resultado do Tratamento , Adulto Jovem
3.
Am J Case Rep ; 22: e931616, 2021 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-33963170

RESUMO

BACKGROUND Rhabdomyolysis occurs when muscle injury leads to the release of muscle cell constituents into circulation, often leading to significant systemic complications. There are many causes of rhabdomyolysis, and the etiology is often multifactorial or unclear. Current data suggest that acute COVID-19 may cause muscle injury that can lead to rhabdomyolysis, particularly in cases of severe illness requiring prolonged hospitalization; however, data on the long-term effects of COVID-19 on the musculoskeletal system are lacking. CASE REPORT We present a case of a woman with generalized weakness 1 week following discharge from the hospital after a prolonged admission for severe COVID-19. She was found to have acute kidney injury and elevated creatine kinase (CK) of 1775 U/L (normal 36-234 U/L). Her home medications, including her statin, were held, but her CK continued to rise, peaking at 15 085 U/L, and she developed renal failure necessitating renal replacement therapy. A thorough work-up for the underlying etiology of her rhabdomyolysis was pursued, including testing for autoimmune myositis, statin-associated necrotizing autoimmune myositis, and a muscle biopsy, which were all unrevealing. Ultimately, the patient's rhabdomyolysis was determined to likely be secondary to a post-viral myopathy from COVID-19. A toxic myopathy from medication use or a delayed critical illness myopathy from her recent prolonged hospitalization could have also contributed. CONCLUSIONS This case highlights the wide differential diagnosis of rhabdomyolysis in the setting of recent COVID-19 and prolonged hospitalization. It demonstrates the possibility that muscle injury and resultant rhabdomyolysis may be a late complication of COVID-19 that is not yet fully described in the literature.


Assuntos
COVID-19 , Doenças Musculares , Miosite , Rabdomiólise , Feminino , Humanos , Rabdomiólise/induzido quimicamente , Rabdomiólise/diagnóstico , SARS-CoV-2
4.
Am J Case Rep ; 22: e929758, 2021 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-33838028

RESUMO

BACKGROUND Primary aldosteronism, also known as Conn's syndrome, is a clinical condition caused by excessive production of aldosterone. The classic presenting signs of primary aldosteronism are hypertension and hypokalemia. However, rhabdomyolysis induced by severe hypokalemia is a rare manifestation of primary aldosteronism. There were only a few cases presented in the English literature over the last 4 decades. CASE REPORT We present 2 cases, a 53-year-old man and a 46-year-old man, with severe hypokalemia-induced rhabdomyolysis caused by adrenal tumor-related primary aldosteronism. Both of these patients were under medical treatment with oral anti-hypertension drug for hypertension, but were poorly controlled. They both presented to the Emergency Department with muscle weakness and pain. Laboratory testing showed elevated creatinine phosphokinase (CPK) and low serum potassium levels. Hypokalemia-induced rhabdomyolysis was suspected. A further endocrine survey showed low PRA (plasma renin activity) and high aldosterone levels, finding which are compatible with primary aldosteronism. Computed tomography (CT) was arranged for further evaluation, and adrenal tumors were found in both cases. Both patients underwent robotic-assisted laparoscopic adrenalectomy. In both cases, there was no recurrence of hypokalemia without potassium supplementation, and their hypertension was under better control at further follow-up visits. CONCLUSIONS Hypokalemic rhabdomyolysis is a rare manifestation of primary aldosteronism. It might be difficult to making a diagnosis when rhabdomyolysis and severe hypokalemia are the first manifestations in patients with primary aldosteronism. The use of diuretics for hypertension treatment might be a risk factor for extremely low potassium levels, which can induce rhabdomyolysis in patients with primary aldosteronism.


Assuntos
Neoplasias das Glândulas Suprarrenais , Hiperaldosteronismo , Hipertensão , Hipopotassemia , Rabdomiólise , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Aldosterona , Humanos , Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnóstico , Hipertensão/complicações , Hipopotassemia/etiologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Rabdomiólise/diagnóstico , Rabdomiólise/etiologia
6.
BMJ Case Rep ; 14(3)2021 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-33782060

RESUMO

Lower lumbar paraspinal muscles constitute a compartment as they are surrounded by distinct fascial and bony boundaries. Lumbar paraspinal compartment syndrome is a rare entity, often caused by intense exercise, but also can be a postoperative complication. We present a 60-year-old man with low back pain, numbness in the left lower back and radicular pain in the left lower extremity, which started after a surgery that involved prolonged positioning on the left side 7 years before, and persisted to the day of evaluation. There was an immediate transient rise in the creatine kinase after surgery. Electromyography showed a left lower lumbar-sacral plexopathy and a lumbar spine MRI revealed fatty infiltration of the lower lumbar-sacral paraspinal muscles. The emergence of radicular lower limb pain was likely due to the compression of the proximal portion of lumbar-sacral plexus during the acute stage of rhabdomyolysis.


Assuntos
Síndromes Compartimentais , Dor Lombar , Rabdomiólise , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Humanos , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Músculos Paraespinais/diagnóstico por imagem , Rabdomiólise/diagnóstico , Rabdomiólise/etiologia
7.
Curr Sports Med Rep ; 20(3): 169-178, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33655999

RESUMO

ABSTRACT: Exertional rhabdomyolysis (ER) is an uncommon condition with a paucity of evidence-based guidance for diagnosis, management, and return to duty or play. Recently, a clinical practice guideline for diagnosis and management of ER in warfighters was updated by a team of military and civilian physicians and researchers using current scientific literature and decades of experience within the military population. The revision concentrated on challenging and controversial clinical questions with applicability to providers in the military and those in the greater sports medicine community. Specific topics addressed: 1) diagnostic criteria for ER; 2) clinical decision making for outpatient versus inpatient treatment; 3) optimal strategies for inpatient management; 4) discharge criteria; 5) identification and assessment of warfighters/athletes at risk for recurrent ER; 6) an appropriate rehabilitative plan; and finally, 7) key clinical questions warranting future research.


Assuntos
Militares , Rabdomiólise/diagnóstico , Rabdomiólise/terapia , Assistência Ambulatorial , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/terapia , Biomarcadores/sangue , Tomada de Decisão Clínica , Hospitalização , Humanos , Condicionamento Físico Humano/efeitos adversos , Esforço Físico , Recidiva , Volta ao Esporte , Retorno ao Trabalho , Rabdomiólise/complicações , Rabdomiólise/etiologia , Fatores de Risco , Urinálise
8.
Praxis (Bern 1994) ; 110(2): 75-76, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33530780

RESUMO

CME/Answers: Elevated Creatine Kinase as a Diagnostic Parameter of Rhabdomyolysis Abstract. Elevated CK values with or without symptoms require clarification in order to rule out possible secondary complications. Adequate hydrogenation, discontinuation of possibly triggering drugs and noxious agents, and close laboratory controls are decisive for the outcome. Acute rhabdomyolysis can have various causes, which can generally be classified as traumatic or atraumatic. In case of recurrent occurrence, genetic or autoimmunological diseases must also be excluded. In addition to a detailed anamnesis, physical examination, laboratory and urine tests, a variety of diagnostic methods are available, which should be used selectively. The aim of this work is to address possible clarification strategies, causes and differential diagnoses of an increase in creatine kinase and rhabdomyolysis. We illustrate these with a case.


Assuntos
Injúria Renal Aguda , Rabdomiólise , Injúria Renal Aguda/diagnóstico , Creatina Quinase , Diagnóstico Diferencial , Humanos , Exame Físico , Rabdomiólise/diagnóstico , Rabdomiólise/etiologia
9.
Intern Med J ; 51(2): 264-267, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33631858

RESUMO

Rhabdomyolysis is a clinical syndrome with significant morbidity and mortality that occurs as a result of traumatic and non-traumatic aetiologies. Acute kidney injury, the need for dialysis, and death, can occur due to rhabdomyolysis. This study explores the aetiologies, clinical outcomes and associated factors for poor outcomes in a cohort of patients with rhabdomyolysis in a tertiary trauma centre in Australia.


Assuntos
Injúria Renal Aguda , Rabdomiólise , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Austrália/epidemiologia , Estudos de Coortes , Humanos , Estudos Retrospectivos , Rabdomiólise/diagnóstico , Rabdomiólise/epidemiologia , Rabdomiólise/terapia , Centros de Traumatologia
10.
Praxis (Bern 1994) ; 110(1): 2-8, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33406933

RESUMO

CME: Elevated Creatine Kinase as a Diagnostic Parameter of Rhabdomyolysis Abstract. Elevated CK values with or without symptoms require clarification in order to rule out possible secondary complications. Adequate hydrogenation, discontinuation of possibly triggering drugs and noxious agents, and close laboratory controls are decisive for the outcome. Acute rhabdomyolysis can have various causes, which can generally be classified as traumatic or atraumatic. In case of recurrent occurrence, genetic or autoimmunological diseases must also be excluded. In addition to a detailed anamnesis, physical examination, laboratory and urine tests, a variety of diagnostic methods are available, which should be used selectively. The aim of this work is to address possible clarification strategies, causes and differential diagnoses of an increase in creatine kinase and rhabdomyolysis. We illustrate these with a case.


Assuntos
Injúria Renal Aguda , Rabdomiólise , Creatina Quinase , Humanos , Rabdomiólise/diagnóstico , Rabdomiólise/etiologia
11.
BMC Infect Dis ; 21(1): 110, 2021 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-33485297

RESUMO

BACKGROUND: Compelling evidence indicates that status epilepticus is a prevalent cause of rhabdomyolysis. However, cases of rhabdomyolysis induced by a single seizure accompanied by viral encephalitis are rarely reported. Herein, we present a case of adult Herpes Simplex Encephalitis complicated with rhabdomyolysis. CASE PRESENTATION: A 32-year-old male was patient presented with fever accompanied by episodes of convulsions, myalgia, and oliguria, which exacerbated the delirium. Routine blood examination showed impaired kidney function and elevated myoglobin (Mb) and creatine phosphokinase (CK) levels. MRI scanning revealed a damaged frontotemporal lobe and limbic system. In addition, herpes simplex virus (HSV) pathogen was identified in the cerebrospinal fluid thus indicating HSV infection. Therefore, a diagnosis of rhabdomyolysis triggered by HSV infection accompanied by epilepsy was made. Notably, the patient recovered well after early intervention and treatment. CONCLUSION: The case presented here calls for careful analysis of rhabdomyolysis cases with unknown causes, minor seizures, and without status epilepticus. This case also indicates that HSV virus infection might contribute to the rhabdomyolysis.


Assuntos
Encefalite por Herpes Simples/complicações , Encefalite por Herpes Simples/diagnóstico , Rabdomiólise/diagnóstico , Rabdomiólise/etiologia , Adulto , Febre/diagnóstico , Febre/etiologia , Febre/patologia , Febre/fisiopatologia , Humanos , Masculino , Rabdomiólise/patologia , Rabdomiólise/fisiopatologia , Convulsões/diagnóstico , Convulsões/etiologia , Convulsões/patologia , Convulsões/fisiopatologia , Simplexvirus/isolamento & purificação
12.
Rev. Soc. Bras. Med. Trop ; 54: e20200319, 2021. graf
Artigo em Inglês | LILACS, Coleciona SUS, Sec. Est. Saúde SP | ID: biblio-1143888

RESUMO

Abstract Bee venom is a natural toxin composed of several peptides. Massive envenoming causes severe local and systemic reactions. We report two cases of severe bee envenomation, of which one was fatal. We also describe clinical characteristics and immune markers. Both victims suffered from respiratory distress, renal failure, rhabdomyolysis, and shock. They required invasive mechanical ventilation, vasoactive drugs, and renal replacement therapy. Moreover, serum levels of chemokines, cytokines, and cell-free circulating nucleic acids demonstrated an intense inflammatory process. Massive envenoming produced systemic injury in the victims, with an uncontrolled inflammatory response, and a more significant chemotactic response in the fatal case.


Assuntos
Animais , Rabdomiólise/diagnóstico , Rabdomiólise/etiologia , Venenos de Abelha , Mordeduras e Picadas de Insetos/complicações , Abelhas , Brasil , Biomarcadores
13.
Rev Soc Bras Med Trop ; 54: e20200319, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33338119

RESUMO

Bee venom is a natural toxin composed of several peptides. Massive envenoming causes severe local and systemic reactions. We report two cases of severe bee envenomation, of which one was fatal. We also describe clinical characteristics and immune markers. Both victims suffered from respiratory distress, renal failure, rhabdomyolysis, and shock. They required invasive mechanical ventilation, vasoactive drugs, and renal replacement therapy. Moreover, serum levels of chemokines, cytokines, and cell-free circulating nucleic acids demonstrated an intense inflammatory process. Massive envenoming produced systemic injury in the victims, with an uncontrolled inflammatory response, and a more significant chemotactic response in the fatal case.


Assuntos
Venenos de Abelha , Mordeduras e Picadas de Insetos , Rabdomiólise , Animais , Abelhas , Biomarcadores , Brasil , Mordeduras e Picadas de Insetos/complicações , Rabdomiólise/diagnóstico , Rabdomiólise/etiologia
16.
Medicine (Baltimore) ; 99(43): e22924, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120846

RESUMO

RATIONALE: Polymyxin B has been used to treat extensively drug-resistant gram-negative bacteria and shown a better antibacterial effect in the clinic at present. Meanwhile, polymyxin B is associated with several adverse effects. However, there is a lack of awareness that polymyxin B can cause rhabdomyolysis. In this study, we firstly report a case of polymyxin B-induced rhabdomyolysis during antiinfection therapy. PATIENT CONCERNS: A 70-year-old woman suffering from rheumatic heart disease underwent aortic and mitral valve replacement at our institute. Subsequently, she developed bacteremia and pneumonia caused by extensively drug resistance-acinetobacter baumannii. Polymyxin B was administered for 5 days. During treatment, the patient complained of muscle pain and limb weakness, and her serum creatine phosphokinase and myoglobin levels rose. DIAGNOSIS: The clinical symptoms and laboratory examination confirmed rhabdomyolysis, and polymyxin B-induced rhabdomyolysis was considered. INTERVENTION: We ceased polymyxin B treatment and monitored the patient daily. OUTCOMES: Serum creatine phosphokinase levels returned to normal, myoglobin levels decreased, and muscle pain was significantly alleviated after cessation of polymyxin B. We identified this as a case of polymyxin B-induced rhabdomyolysis. LESSONS: Here, we report the first reported case of rhabdomyolysis induced by polymyxin B administration. The awareness of rare adverse reaction helps ensure the clinical safety of polymyxin B treatment.


Assuntos
Antibacterianos/efeitos adversos , Polimixina B/efeitos adversos , Rabdomiólise/induzido quimicamente , Acinetobacter baumannii/isolamento & purificação , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Conscientização , Bacteriemia/tratamento farmacológico , Creatina Quinase/sangue , Feminino , Humanos , Debilidade Muscular/etiologia , Mialgia/etiologia , Mioglobina/sangue , Pneumonia/tratamento farmacológico , Pneumonia/microbiologia , Polimixina B/administração & dosagem , Polimixina B/uso terapêutico , Rabdomiólise/diagnóstico , Suspensão de Tratamento
17.
BMJ Case Rep ; 13(9)2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32878841

RESUMO

We report the case of a 38-year-old man who presented to the emergency department with fever, myalgia, nausea, vomiting, dry cough, breathlessness and abdominal pain. He was admitted due to hypoxaemia and was diagnosed with SARS-CoV-2 and was subsequently referred to the intensive care unit for intubation and mechanical ventilation. Severe rhabdomyolysis and acute kidney injury developed 4 days later and were suspected after noticing discolouration of the urine and a marked increase in plasma myoglobin levels. Treatment included hydration, forced diuresis and continuous renal replacement therapy. In addition to the coronavirus disease acute respiratory distress syndrome, he was diagnosed with possible SARS-CoV-2-induced myositis with severe rhabdomyolysis and kidney failure. The patient survived and was discharged from intensive care after 12 days, returning home 23 days after hospitalisation, fully mobilised with a partially restored kidney function.


Assuntos
Injúria Renal Aguda/diagnóstico , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Rabdomiólise/diagnóstico , Doença Aguda , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Adulto , Antibacterianos/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Terapia de Substituição Renal/métodos , Rabdomiólise/etiologia , Rabdomiólise/terapia , Resultado do Tratamento
19.
Am J Trop Med Hyg ; 103(3): 1158-1161, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32729460

RESUMO

COVID-19 represents the greatest health challenge of modern years. The spectrum of illness comprises respiratory and non-respiratory manifestations. We report the case of an adult man with COVID-19 who presented with rhabdomyolysis as a principal extrapulmonary manifestation. Our patient presented with dyspnea, fever, and muscle pain. After a comprehensive approach, the diagnosis of COVID-19 and rhabdomyolysis was made. He developed acute kidney injury requiring renal replacement therapy without reversibility, despite optimal treatment. We performed a literature search for similar cases, discuss the potential mechanisms implied, and propose a diagnostic-therapeutic algorithm.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Rabdomiólise/etiologia , Injúria Renal Aguda/etiologia , Algoritmos , Infecções por Coronavirus/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico por imagem , Rabdomiólise/diagnóstico , Rabdomiólise/terapia
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