Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, South Korea.
Department of Internal Medicine, HANSUNG Union Internal Medicine Clinic and Dialysis Center, Daegu, South Korea.
Am J Case Rep. 2022 Jun 8;23:e936407. doi: 10.12659/AJCR.936407.
BACKGROUND Rhabdomyolysis is a clinical syndrome characterized by elevated serum creatine kinase (CK) and myoglobin levels due to the breakdown of muscle fibers and is associated with symptoms such as myalgia, muscle swelling, and erythruria. Rhabdomyolysis has an array of potential causes, including Salmonella infection, although rare. We report 2 cases in which nontyphoidal salmonellae caused acute gastroenteritis complicated by rhabdomyolysis and myoglobinuric acute kidney injury (AKI). CASE REPORT Two male patients, aged 69 years and 62 years, presented to our hospital with sudden-onset fever, abdominal pain, and watery diarrhea. At the time of admission, the patients had elevated serum CK levels (32 225 U/L and 10 590 U/L, respectively) and serum creatinine levels (4.8 mg/dL and 8.8 mg/dL, respectively). Both patients also had elevated serum myoglobin concentrations with significant myoglobinuria. They were administered fluid therapy and intravenous empirical antibiotics (cefotaxime and metronidazole for Case 1, ciprofloxacin for Case 2). The patient in Case 2 underwent 3 sessions of hemodialysis due to persistent oliguria and exacerbation of metabolic acidosis. Salmonella B (Case 1) and Salmonella C (Case 2) were isolated from blood cultures. After about 2 weeks of inpatient care, both patients showed improvement of clinical symptoms and were discharged. CONCLUSIONS Patients with acute gastroenteritis induced by Salmonella infection can develop rhabdomyolysis and myoglobinuric AKI in rare cases. Timely administration of appropriate antibiotics and fluids is expected to produce a favorable prognosis. Furthermore, early initiation of hemodialysis after onset of oliguric AKI can improve clinical outcomes.
横纹肌溶解症是一种临床综合征，其特征为血清肌酸激酶（CK）和肌红蛋白水平升高，由于肌纤维破裂所致，并伴有肌痛、肌肉肿胀和血尿等症状。横纹肌溶解症有多种潜在病因，包括沙门氏菌感染，尽管较为罕见。我们报告 2 例非伤寒沙门氏菌引起的急性肠胃炎并发横纹肌溶解症和肌红蛋白尿性急性肾损伤（AKI）。
2 名男性患者，年龄分别为 69 岁和 62 岁，因突发发热、腹痛和水样腹泻就诊于我院。入院时，患者血清 CK 水平（分别为 32225U/L 和 10590U/L）和血清肌酐水平（分别为 4.8mg/dL 和 8.8mg/dL）升高。两名患者的血清肌红蛋白浓度均升高，且有明显肌红蛋白尿。患者接受了液体疗法和静脉经验性抗生素治疗（头孢噻肟和甲硝唑用于病例 1，环丙沙星用于病例 2）。由于持续少尿和代谢性酸中毒加重，病例 2 患者接受了 3 次血液透析。从血培养中分离出肠炎沙门氏菌（病例 1）和肠炎沙门氏菌 C 型（病例 2）。经过大约 2 周的住院治疗，两名患者的临床症状均有改善并出院。
由沙门氏菌感染引起的急性肠胃炎患者在极少数情况下可发展为横纹肌溶解症和肌红蛋白尿性 AKI。及时给予适当的抗生素和液体有望产生良好的预后。此外，少尿型 AKI 发病后早期开始血液透析可改善临床结局。
