Rhabdomyolysis after ERCP in a patient with pancreatic adenocarcinoma: a paraneoplastic phenomenon?

Paraneoplastic myopathies are rare complications of malignancy, most often associated with lung, ovarian, and gastrointestinal cancers. Rhabdomyolysis as a paraneoplastic manifestation of pancreatic adenocarcinoma is exceedingly uncommon and typically portends a poor prognosis.

We describe an 80-year-old male with newly diagnosed pancreatic adenocarcinoma who developed fulminant rhabdomyolysis shortly after endoscopic ultrasound and ERCP with biliary stent placement. Laboratory studies showed CPK levels > 66 000 U/l and serum myoglobin > 40 000 ng/ml, leading to acute kidney injury and multiorgan failure despite aggressive fluid resuscitation, corticosteroids, CRRT, and broad-spectrum antibiotics. Autoimmune and paraneoplastic serologies were unrevealing. The patient died on hospital day five.

The rapid onset of rhabdomyolysis following ERCP raises the possibility that tumor manipulation or antigenic exposure may serve as an immune trigger for paraneoplastic muscle injury.