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A case of rhabdomyolysis in chronic renal failure
Abstract:
Rhabdomyolysis can be induced by a variety of physical and chemical insults to skeletal muscle. Though there are only a few reports of myositis associated with viral diseases, and no reported cases of virus-induced rhabdomyolysis in uremic patients. Chronic uremic states have been known to potentiate a variety of metabolic and immunological abnormalities. Present case had an acute, progressive and fatal rhabdomyolysis which was thought to be induced by virus infection. A 43-year-old man had received hemodialysis therapy for 8 years. He suffered from an upper respiratory tract infection 11 days before admission. On admission, he was diagnosed as rhabdomyolysis with severe lactic acidosis and marked hyperkalemia. Although intensive care had been performed, he died of uncontrollable hyperkalemia (10.0 mEq/L) 2 days after admission. Maximum CPK and GOT levels were 105,200 and 56,800 mU/ml, respectively. Most probable cause of rhabdomyolysis was thought to be Parainfluenza type-3 infection, though histological examination failed to prove virus infection.
Insights
This case study reports a fatal case of rhabdomyolysis in a hemodialysis patient, potentially triggered by a viral infection. It highlights the severe complications, including hyperkalemia, that can arise in uremic individuals.
Area of Science:
- Nephrology
- Virology
- Pathology
Background:
- Chronic uremia presents metabolic and immunological challenges.
- Rhabdomyolysis is typically caused by physical or chemical muscle injury.
- Viral myositis is rare, and virus-induced rhabdomyolysis in uremic patients is undocumented.
Observation:
- A 43-year-old male on long-term hemodialysis developed acute, progressive rhabdomyolysis.
- Symptoms began 11 days after an upper respiratory tract infection.
- The patient presented with severe lactic acidosis and hyperkalemia.
Findings:
- The patient experienced fatal uncontrollable hyperkalemia (10.0 mEq/L) despite intensive care.
- Peak creatine phosphokinase (CPK) and aspartate aminotransferase (GOT) levels were significantly elevated.
- Parainfluenza type-3 infection was suspected as the cause, but not histologically confirmed.
Implications:
- This case suggests viral infections may precipitate severe rhabdomyolysis in uremic patients.
- It underscores the critical need for vigilance regarding potential infectious triggers in dialysis patients.
- Further research is warranted to explore the link between viral infections and rhabdomyolysis in chronic kidney disease.