Yasumoto N, Hara M, Kitamoto Y, Nakayama M, Sato T
Department of Medicine, Yatsushiro General Hospital, Japan.
Intern Med. 1992 Mar;31(3):426-30. doi: 10.2169/internalmedicine.31.426.
The occurrence of rhabdomyolysis and acute renal failure associated with cytomegaloviral infection is rare. A 27-year-old housewife was admitted to our hospital with complaints of thirst, muscle weakness, abdominal pain and oliguria. There was no past history of diabetes, drinking, fever or drug habituation and a negative family history. Laboratory tests revealed myoglobinuria, hyper-pancreatic type amylaseuria, hyperglycemia, azotemia and highly increased creatine phosphokinase in the plasma. She was treated with hemodialysis and insulin therapy. Serological studies showed a 4-fold increase in cytomegalovirus antibody titers 4 weeks after admission. Muscle biopsy specimens showed hyaline degeneration and infiltration of T cell lymphocytes in the muscle. Renal biopsy specimens showed acute tubular necrosis and some myoglobin casts. No cytomegalovirus antigen was found in renal specimens by immunofluorescence study. From these results, it was determined that a systemic cytomegalovirus infection triggered pancreatitis which caused diabetic ketoacidosis, rhabdomyolysis and acute renal failure.
与巨细胞病毒感染相关的横纹肌溶解症和急性肾衰竭很少见。一名27岁的家庭主妇因口渴、肌肉无力、腹痛和少尿入院。既往无糖尿病、饮酒、发热或药物成瘾史，家族史阴性。实验室检查显示有肌红蛋白尿、高胰淀粉酶尿、高血糖、氮质血症以及血浆中肌酸磷酸激酶大幅升高。她接受了血液透析和胰岛素治疗。血清学研究显示入院4周后巨细胞病毒抗体滴度增加了4倍。肌肉活检标本显示肌肉中有透明变性和T淋巴细胞浸润。肾活检标本显示急性肾小管坏死和一些肌红蛋白管型。免疫荧光研究在肾标本中未发现巨细胞病毒抗原。根据这些结果，确定全身性巨细胞病毒感染引发了胰腺炎，进而导致糖尿病酮症酸中毒、横纹肌溶解症和急性肾衰竭。
