[Alcoholic rhabdomyolysis with myocardial involvement]

A case of severe rhabdomyolysis with extensive myocardial involvement in a 32 year old alcoholic man is reported. He referred effort dyspnea for the last eight months which worsened thirteen days before his death. Admitted at the institute he was obnubilated and dyspneic. Massive pulmonary thromboembolism was suspected and heparin was given. He was then transferred to our intensive care unit in circulatory collapse. A chest Rx showed cardiomegaly. A Swan-Ganz catheter was introduced and abnormal parameters corrected. Evolution was complicated with acute cholecystitis, nosocomial bronchopneumonia and hypoxic brain damage. A net reduction of cardiac size as judged by a chest roentgenogram was noted in the final days. Necropsy showed skeletal and cardiac rhabdomyolysis, early alcoholic cirrhosis, diffuse peritonitis and bronchopneumonia. To our knowledge, this case is the first in the literature to provide anatomical evidence of cardiac rhabdomyolysis, a fact which was suspected on clinical grounds but had not been proven.