Bacillus cereus septicemia associated with rhabdomyolysis and myoglobinuric renal failure

A patient with acute myeloblastic leukemia (AML) developed septicemia due to Bacillus cereus with subsequent rhabdomyolysis and myoglobinuric renal failure. He died despite intensive care. Postmortem examination revealed diffuse muscle necrosis with infiltration of Gram-positive bacilli and widespread bacterial microthrombi in various organs. Septicemia associated with rhabdomyolysis has been described in 12 cases. This case represents the first reported case of B. cereus septicemia associated rhabdomyolysis. Renal failure and shock were considered to be the most important prognostic factors, and either direct infiltration or toxin of the bacteria was suggested to be the mechanism of rhabdomyolysis in sepsis. B. cereus can be one of the lethal organisms in immunocompromised patient such as the present case. Rhabdomyolysis should be considered when a patient with septicemia complains of muscle pain. Prompt hydration and correction of acidosis are important to prevent renal failure and shock.