RECURRENT RHABDOMYOLYSIS J. K. Khera, DO, J. Schouest MD, G. Ardoin MD Department of Medicine, University Hospital and Clinics, LSU Health, Lafayette, LA
INTRODUCTION: Rhabdomyolysis entails the destruction of skeletal muscles whichmay be asymptomatic or set the stage for fulminant renal failure. The common causes of rhabdomyolysis are extensive yet some patients possess a low threshold for supervening recurrent rhabdomyolysis. Such patients with recurrent episodes require testing to rule out acquired myopathies such as dermatomyositis and polymyositis, muscular dystrophy, and metabolic myopathies such as disorders of fat and carbohydrate metabolism, and mitochondrial function. CASE: A 30 year old man presented with body aches, dark urine, and malaise with a CK of 84,000. Five days prior to admission, he was tested positive for Influenza B. Remarkably this was the patient’s fourth episode in the past four years with the first case being a complicated course secondary to influenza B infection and the two subsequent cases being vague in nature. His employment during these times involved minimal exertion in colder temperatures. Given his predisposition, he received a muscle biopsy two years ago showing muscle strands consistent with typical rhabdomyolysis but the cause could not be established. Thyroid stimulating hormone, HIV, urine drug screens, anti-nuclear antibody, and myositis panels were non- diagnostic. He was evaluated by Nephrology, Endocrine, Rheumatology, and Neurology. Post discharge, he was scheduled for follow-up with rheumatology and blood samples were sent to the Lantern Project to test for neuromuscular diseases. DISCUSSION: Rhabdomyolysis stemming from influenza is surely a known cause but in this case, we are suspect an underlying muscle disorder as the root of illness because two of four episodes were not secondary to a viral illness. Furthermore, episodes that ensued from the influenza infection were out of proportion to the degree of viral illness. This case is perplexing because of the low threshold for recurrent muscle breakdown that has been twice unveiled by Influenza B, yet in the other two instances the true etiology remains a mystery despite thorough investigations. We felt that a referral to a myopathy specialist was warranted because an underlyingmetabolic or muscle storage disorder seems most likely to be encouraging recurrent rhabdomyolysis.
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