Daher Elizabeth F, Lima Rafael S A, Silva Júnior Geraldo B, Almeida João Paulo C, Siqueira Francisco Júlio W S, Santos Silvia Q, Silva Stephanie W, Libório Alexandre B
Department of Internal Medicine, Division of Nephrology, Faculdade de Medicina, Hospital Universitário Walter Cantidio, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
Acta Biomed. 2008 Dec;79(3):246-50.
Rhabdomyolysis is associated with infectious diseases in approximately 5% of cases and acute kidney injury occurs in 33-50% of cases. Gangrenous myositis is a deep seated infection of the subcutaneous and muscular tissues. We report the case of an 18 year-old man who was admitted to the emergency room with leg pain, fever, nausea, vomiting and oliguria. Physical examination showed moderate dehydration, peripheral cyanosis and skin necrosis with severe myalgia and no subcutaneous gas. Laboratory findings at admission were: serum urea 111 mg/dL, creatinine 1.3 mg/dL, potassium 6.3 mEq/L, creatine kinase (CK) 112,452 IU/L, aspartate amino transaminase (AST) 1116 IU/L, alanine amino transaminase (ALT) 1841 IU/L, pH 7.31, bicarbonate (HCO3) 11 mEq/L and lactate 4.3 mmol/L. Emergency hemodyalisis was started, and antibiotics were given due to high suspicion for bacterial infection. The patient developed respiratory insufficiency and septic shock needing mechanical ventilation and vasoactive drugs. He presented spontaneous gangrenous myositis in both legs and in his left arm. After 26 sessions of hemodialysis, partial recovery of renal function was observed. He was discharged from the ICU after 38 days, still with leg pain. Acute kidney injury due to rhabdomyolysis should be considered as a possible complication of gangrenous myositis.
横纹肌溶解症在约5%的病例中与感染性疾病相关，33%-50%的病例会发生急性肾损伤。坏疽性肌炎是皮下和肌肉组织的深部感染。我们报告一例18岁男性病例，该患者因腿痛、发热、恶心、呕吐和少尿入住急诊室。体格检查显示中度脱水、外周发绀和皮肤坏死，伴有严重肌痛，无皮下气肿。入院时实验室检查结果如下：血清尿素111mg/dL、肌酐1.3mg/dL、钾6.3mEq/L、肌酸激酶（CK）112452IU/L、天冬氨酸氨基转移酶（AST）1116IU/L、丙氨酸氨基转移酶（ALT）1841IU/L、pH值7.31、碳酸氢盐（HCO3）11mEq/L、乳酸4.3mmol/L。开始进行紧急血液透析，由于高度怀疑细菌感染给予了抗生素治疗。患者出现呼吸功能不全和感染性休克，需要机械通气和血管活性药物治疗。他双下肢和左臂出现自发性坏疽性肌炎。经过26次血液透析后，观察到肾功能部分恢复。38天后他从重症监护病房出院，仍有腿痛。横纹肌溶解症所致急性肾损伤应被视为坏疽性肌炎可能的并发症。
