Polymyxin B-induced rhabdomyolysis: A case report
Ming Ni1,2, Xiangdong Meng3, Limin Wang3
1Department of Clinical Pharmacy, Henan Provincial People's Hospital.
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.
Insights
This case report details the first instance of rhabdomyolysis, a rare adverse reaction, linked to Polymyxin B treatment. Prompt cessation of the antibiotic led to symptom resolution, highlighting the need for clinical awareness.
Area of Science:
- Clinical Medicine
- Pharmacology
- Infectious Diseases
Background:
- Polymyxin B is a critical antibiotic for treating extensively drug-resistant Gram-negative bacterial infections.
- While effective, Polymyxin B is known to cause various adverse effects.
- Awareness of potential rare side effects like rhabdomyolysis is crucial for safe clinical use.
Observation:
- A 70-year-old female patient developed bacteremia and pneumonia due to extensively drug-resistant *Acinetobacter baumannii* post-valve replacement surgery.
- Polymyxin B was administered for five days, during which the patient reported muscle pain and weakness.
- Elevated serum creatine phosphokinase and myoglobin levels were observed.
Findings:
- Clinical presentation and laboratory results confirmed rhabdomyolysis.
- Discontinuation of Polymyxin B led to normalization of creatine phosphokinase and myoglobin levels, with significant improvement in muscle pain.
- This confirmed a diagnosis of Polymyxin B-induced rhabdomyolysis.
Implications:
- This study reports the first documented case of rhabdomyolysis associated with Polymyxin B.
- Recognizing this rare adverse reaction is vital for enhancing patient safety during Polymyxin B therapy.
- Clinicians should consider rhabdomyolysis in patients presenting with muscle symptoms during Polymyxin B treatment.
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