Luckoor Pavan, Salehi Mashal, Kunadu Afua
Department of Medicine, New York City Health + Hospital, Columbia University, Harlem, NY, USA.
Am J Case Rep. 2017 Jul 4;18:746-749. doi: 10.12659/ajcr.905089.
BACKGROUND Rhabdomyolysis is a syndrome caused by muscle breakdown. It can be caused by traumatic as well as non-traumatic factors such as drugs, toxins, and infections. Although it has been initially associated with only traumatic causes, non-traumatic causes now appear to be at least 5 times more frequent. In rhabdomyolysis, the CK levels can range anywhere from 10 000 to 200 000 or even higher. The higher the CK levels, the greater will be the renal damage and associated complications. We present the case of a patient with exceptionally massive rhabdomyolysis with unusually high CK levels (nearly 1 million) caused by combined etiologic factors and complicated with acute renal failure. CASE REPORT A 36-year-old African American male patient with no significant past medical history and a social history of cocaine and alcohol abuse presented with diarrhea and generalized weakness of 2 days' duration. He was found to be febrile, tachycardic, tachypneic, and hypoxic. The patient was subsequently intubated and admitted to the medical ICU. Laboratory work-up showed acute renal failure with deranged liver functions test results, and elevated creatine kinase of 701,400 U/L. CK levels were subsequently too high for the lab to quantify. Urine legionella testing was positive for L. pneumophilia serogroup 1 antigen and urine toxicology was positive for cocaine. The patient had a protracted course in the ICU. He was initially started on CVVH, and later received intermittent hemodialysis for about 1 month. CONCLUSIONS In the presence of multiple etiologic factors, rhabdomyolysis can be massive with resultant significant morbidity. Clinicians should have a high index of suspicion for rhabdomyolysis in the presence of multiple factors, as early recognition of this diseases is very important in the prevention and active management of life-threatening conditions.
横纹肌溶解症是一种由肌肉分解引起的综合征。它可由创伤性因素以及非创伤性因素如药物、毒素和感染引发。尽管它最初仅与创伤性病因相关，但现在非创伤性病因似乎至少比创伤性病因常见5倍。在横纹肌溶解症中，肌酸激酶（CK）水平可在10000至200000甚至更高的范围内波动。CK水平越高，肾损伤及相关并发症就越严重。我们报告一例由多种病因导致的、CK水平异常高（近100万）并伴有急性肾衰竭的极其严重的横纹肌溶解症患者。
一名36岁的非裔美国男性患者，既往无重大病史，有可卡因和酒精滥用的社会史，出现腹泻和持续2天的全身无力症状。发现他发热、心动过速、呼吸急促且缺氧。该患者随后接受插管并入住内科重症监护病房（ICU）。实验室检查显示急性肾衰竭，肝功能检查结果异常，肌酸激酶升高至701400 U/L。随后CK水平过高，实验室无法进行定量检测。尿液嗜肺军团菌检测显示嗜肺军团菌血清1型抗原呈阳性，尿液毒理学检测显示可卡因呈阳性。该患者在ICU经历了漫长病程。最初开始接受连续性静脉 - 静脉血液滤过（CVVH）治疗，后来接受间歇性血液透析约1个月。
在存在多种病因的情况下，横纹肌溶解症可能非常严重，导致显著的发病率。在存在多种因素时，临床医生对横纹肌溶解症应保持高度怀疑，因为早期识别这种疾病对于预防和积极处理危及生命的情况非常重要。
