Different kinetic profiles of 2 patients presenting with muscle b-enolase deficiency
Ralph WigleyR. ScalcoA. GardinerSuzanne BoothS. ChatfieldRichard GodfreyM. DesikanRichard KirkDavid Hilton‐JonesHenry HouldenRosaline C. M. Quinlivan
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Keywords:
myalgia
Enolase
Muscle weakness
Although patients with COVID-19 can have mild nonspecific myalgia and mild elevation of creatinine kinase levels, severe myalgia along with elevation of creatinine kinase levels >10 times the upper normal limit and dark-colored urine indicate an underlying severe rhabdomyolysis. This report describes a 60-year-old morbidly obese man who was found to have severe rhabdomyolysis, along with acute kidney injury, dark-colored urine, and a positive COVID-19 test. He had a prolonged hospital course requiring continuous renal replacement therapy, mechanical ventilation, and multiple vasopressors and eventually died of multiorgan failure. The management of severe rhabdomyolysis and COVID-19 is challenging, and fluid resuscitation should be done cautiously, monitoring for early signs of fluid overload.
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Renal replacement therapy
Creatine kinase
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A 32-year-old woman with chronic schizophrenia who took 8-10 liters of water for three years due to thirsty, admitted to our hospital because of convulsion and muscle weakness. Neurological finding on admission showed a mild disturbance of consciousness, moderate proximal muscle weakness, and muscle pain. Laboratory examination revealed marked serum hyponatremia(102 mEq/l) and high value of creatin kinase (1,259 IU/l). The level of creatin kinase reached a peak(39,700 IU/l) at the 5th hospital day. An analysis of the muscle biopsy specimen showed necrotic muscle fibers and opaque fibers, that was compatible with rhabdomyolysis. T 2 weighted magnetic resonance imaging of the brain showed a transient high signals in bilateral putamen but not in pons. She was diagnosed to have rhabdomyolysis due to water intoxication. The present case is the first rhabdomyolysis in Japan that was confirmed by muscle biopsy at an acute stage of water intoxication related with schizophrenia.
Muscle weakness
Water intoxication
Creatine kinase
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The news was reported from the Wuhan region of China about a novel corona virus in the end of 2019. After spreading around the world, a pandemic was declared by the WHO. Depending on the different involvement of the disease, the most common symptoms are fever, cough, and dyspnea. However, some indeterminate symptoms that make diagnosis difficult, such as myalgia and fatigue, can also be seen alone, without the typical clinical picture. We describe a patient with COVID-19 pneumonia, the only complaint of which is myalgia, and the first diagnosis is mild rhabdomyolysis. The patient had no evidence or history other than viral infection that could explain muscle pain and also increased level of muscle enzymes. When mild rhabdomyolysis lack of myoglobinuria and complications was diagnosed, treatment-related rhabdomyolysis was also avoided as no treatment related to COVID-19 was initiated yet. Apart from the typical symptoms leading to the typical diagnosis of COVID-19 at the first admission, SARS-CoV-2 related with rhabdomyolysis should also be kept in mind.
myalgia
Myoglobinuria
Pandemic
Viral Pneumonia
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Rhabdomyolysis is a clinical condition characterised by the breakdown of skeletal muscle. It has been attributed to viral infections. We describe a case of coronavirus disease 2019 (COVID-19) in a young male who presented with rhabdomyolysis. Myalgia and fatigue are common complaints in COVID-19 patients. We suggest that patients with COVID-19 be screened for rhabdomyolysis in order to facilitate early treatment with intravenous hydration, thus preventing complications such as acute kidney injury.
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Coronavirus
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Rhabdomyolysis is a rare condition caused by the proteins of damaged muscle cells entering the bloodstream and damaging the kidneys. Common symptoms of rhabdomyolysis are muscle pain and fatigue in conjunction with dark urine; kidney damage is a common symptom among these patients. We present a case of a 23-year-old woman who displayed myalgia in the upper extremities caused by low-intensity and high-repetition exercise. She was successfully diagnosed and treated for exertional rhabdomyolysis. This patient had no significant medical history that would induce this condition. We urge the emergency medical community to observe and monitor patients that complain of myalgia to ensure they are not suffering from rhabdomyolysis even in atypical cases.
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Myoglobinuria
Etiology
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Among 1,076 dengue patients, 9 patients with rhabdomyolysis and 1,067 patients without rhabdomyolysis (controls) were retrospectively analyzed. Of nine patients with rhabdomyolysis, the most commonly reported symptom other than fever was myalgia; dengue hemorrhagic fever (DHF) was found in seven cases, and acute kidney injury was found in six cases. Furthermore, one (11.1%) patient died. The median duration from hospital admission to rhabdomyolysis diagnosis was 3 days. Patients with rhabdomyolysis had higher age, proportion of men, prevalence of hypertension, frequency of myalgia, and incidences of DHF, pleural effusion, and acute kidney injury than controls. Multivariate analysis showed that hypertension (odds ratio [OR] = 14.270), myalgia (OR = 20.377), and acute kidney injury (OR = 65.547) were independent risk factors for rhabdomyolysis. Comparison of cytokine/chemokine concentrations in 101 DHF patients, including those with ( N = 4) and without ( N = 97) rhabdomyolysis, showed that interleukin-6 and tumor necrosis factor-α levels were significantly increased in the former.
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Objective: To report an unusual case of simvastatin-induced rhabdomyolysis and to discuss the occurrence of this potentially fatal adverse effect. Case Summary: A 61-year-old white man was admitted to the hospital with angina and myalgia. Laboratory data obtained on admission confirmed the clinical diagnosis of simvastatin-induced rhabdomyolysis. The medication was discontinued, and the patient's rhabdomyolysis resolved. Three months later, a rechallenge with simvastatin resulted in the recurrence of myalgia and elevation of the creatine kinase concentration. Discontinuation of the medication resulted in improvement of symptoms and return of the creatine kinase concentration to within normal limits. Discussion: Although simvastatin-induced rhabdomyolysis is a well-described entity, the occurrence of rhabdomyolysis at the lowest prescribed dose in the absence of concomitant interacting drugs is rare. The mechanism of this adverse effect is postulated to be related to mitochondrial dysfunction due to a relative deficiency of skeletal muscle Co Q10 induced by the drug. Conclusions: Simvastatin, even at the lowest prescribed dose and in the absence of drugs known to interact adversely with it, can cause potentially life-threatening rhabdomyolysis. This case report shows that cautioning all patients about this rare yet serious adverse effect is critical.
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Discontinuation
Creatine kinase
Concomitant
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Statins are commonly used drugs in the treatment of hyperlipidemia (HL), despite some undesirable side effects. These range from mild symptoms such as myopathy, muscle weakness and myalgia to severe muscle weakness associated with chronic myopathy and acute renal failure (ARF) as a result of rhabdomyolysis. The most serious and deadly side effect of statins is rhabdomyolysis. The case presented here is of a patient with rhabdomyolysis due to treatment with the antihyperlipidemic drug, atorvastatin.
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Muscle weakness
Hyperlipidemia
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Rhabdomyolysis is a condition in which muscle breaks down potentially leading to renal dysfunction, and often occurs secondary to a precipitating factor. Viral or bacterial infections are common precipitants for initiating rhabdomyolysis. Recently, healthcare systems across the world have been challenged by a pandemic of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing ‘coronavirus disease 2019’ (COVID-19) disease. SARS-CoV-2 infection is recognized to cause respiratory and cardiovascular compromise, thromboembolic events, and acute kidney injury (AKI); however, it is not known whether it can precipitate rhabdomyolysis, with only a limited number of cases of SARS-CoV-2 infection preceding rhabdomyolysis reported to date. Here, we report the case of a 64-year-old woman who developed rhabdomyolysis shortly after SARS-CoV-2 infection and COVID-19. She initially presented with muscular pain, a creatine kinase level of 119,301 IU/L, and a mild rise in her creatinine level to 92 µmol/L, but successfully recovered with intravenous fluid support. We also review the literature to summarise previously reported cases of rhabdomyolysis precipitated by SARS-CoV-2, highlighting the need to consider this diagnosis in patients presenting with SARS-CoV-2 and myalgia.
2019-20 coronavirus outbreak
Coronavirus Infections
Pandemic
Betacoronavirus
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Fenoverine is a derivative of phenothiazine. It is commonly used in the treatment of gastrointestinal and gynecological spasmodic disorders. Myalgia is a common side effect, but rhabdomyolysis has only been scarcely reported before. A 77-year-old patient without previous history of liver diseases received fenoverine therapy for four days due to abdominal pain. Acute onset of myalgia, proximal muscle weakness and high creatinine phosphokinase (CK) occurred. The foregoing symptoms and signs and abnormal biochemistry improved gradually after discontinuation of fenoverine use. The pathophysiology of fenoverine-induced rhabdomyolysis is unclear. Some predisposing factors, especially liver cirrhosis, had been reported. However, our patient had none of the well-known precipitating factors. Physicians should be aware of the possibility of rhabdomyolysis in patients receiving fenoverine, whether they are healthy or have musculoskeletal or liver dysfunction.
myalgia
Discontinuation
Creatine kinase
Muscle weakness
Pathophysiology
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