Kaiser A B, Rieves D, Price A H, Gelfand M R, Parrish R E, Decker M D, Evans M E
JAMA. 1985 Jan 11;253(2):241-3.
Rhabdomyolysis as a complication of tularemia occurred in four patients in Tennessee over a four-year period. All patients were severely ill and had renal failure. Tularemia was not suspected initially in any of these patients. One patient died of complications of rhabdomyolysis. At autopsy, multiple abscesses were present within skeletal muscle, suggesting that rhabdomyolysis resulted from direct muscle involvement with Francisella tularensis. Tularemia should be considered in the differential diagnosis of patients with an acute febrile illness and rhabdomyolysis. Conversely, in patients with acute tularemia, the possibility of rhabdomyolysis should be entertained early, especially in those with evidence of myoglobinuria and/or impaired renal function.
在田纳西州，四年期间有4名患者发生了作为兔热病并发症的横纹肌溶解症。所有患者病情都很严重，且出现了肾衰竭。这些患者最初均未被怀疑患有兔热病。1例患者死于横纹肌溶解症的并发症。尸检时，骨骼肌内出现多个脓肿，提示横纹肌溶解症是由土拉弗朗西斯菌直接侵犯肌肉所致。对于患有急性发热性疾病并伴有横纹肌溶解症的患者，鉴别诊断时应考虑兔热病。相反，对于急性兔热病患者，尤其是那些有肌红蛋白尿和/或肾功能受损证据的患者，应尽早考虑横纹肌溶解症的可能性。
