A Rare Case of Erythromycin-Induced Rhabdomyolysis
Zaid Khamis1, Mohammad Aldalahmeh1, Salim Barakat1
1Internal Medicine, Staten Island University Hospital, Staten Island, USA.
Abstract:
Rhabdomyolysis (RML) arises from the breakdown of muscle tissue, leading to the release of intracellular components into the bloodstream and potentially causing multi-organ failure. Multiple drugs have been reported to cause RML. We present here a rare instance of erythromycin-triggered RML in a patient who was not on any other potential RML-inducing medications. A 25-year-old male presented to the ED complaining of a tingling sensation and increased dyspnea with muscle aches. He took erythromycin over the counter for two days before. On presentation, diffuse muscle tenderness was found, and the vitals showed tachycardia and tachypnea. Labs showed elevated creatinine, peaking at 10.1, and elevated creatine kinase (CK) peaking at 1.2 million. He was treated in ICU with aggressive fluid resuscitation. Then he required dialysis due to fluid overload and not responding to diuretics. Extensive workup failed to find a cause for RML. This represents only the second documented instance of erythromycin-induced RML in a patient who is not concurrently using any other myotoxic medications. Before attributing the patient's condition to the erythromycin he was taking, it was essential to rule out the typical triggers of RML. Every physician must be familiar with the symptoms and prevalent triggers of RML.
Insights
This case study highlights a rare instance of erythromycin-induced rhabdomyolysis (RML) in a young male. It emphasizes the importance of considering even common medications as potential triggers for muscle breakdown.
Area of Science:
- Medicine
- Pharmacology
- Toxicology
Background:
- Rhabdomyolysis (RML) is a serious condition involving muscle tissue breakdown.
- Numerous medications are known to induce RML, complicating diagnosis.
- Identifying drug-induced RML requires careful exclusion of other causes.
Observation:
- A 25-year-old male presented with symptoms of RML, including muscle aches, dyspnea, and paresthesia.
- The patient had recently taken over-the-counter erythromycin.
- Physical examination revealed diffuse muscle tenderness, tachycardia, and tachypnea.
Findings:
- Laboratory results showed significantly elevated creatinine and creatine kinase (CK) levels.
- The patient required intensive care, fluid resuscitation, and dialysis due to severe symptoms and fluid overload.
- Extensive investigations ruled out other common causes of RML.
Implications:
- This case represents one of the few documented instances of erythromycin-induced RML without concurrent use of other myotoxic drugs.
- Physicians must maintain a high index of suspicion for drug-induced RML, even with common antibiotics like erythromycin.
- Awareness of RML symptoms and triggers is crucial for timely diagnosis and management.
