1/67. Clinical rhabdomyolysis.Although rhabdomyolysis is an uncommon disorder, especially in children, it can present as a severe, life-threatening event. Paediatricians need to be aware of this important, probably underdiagnosed disorder in order to implement appropriate early treatment. In this report, seven children with rhabdomyolysis of both forms, endogenous and exogenous, are presented. Despite comprehensive 'up-to-date' investigations being performed on paediatric patients with endogenous (often recurrent) rhabdomyolysis, the majority of these patients' underlying disorders will remain undiagnosed. overall, these patients usually have a very good prognosis even if repeated, severe life-threatening episodes occur. It is recommended that a regimen of early therapy with fluids and sodium bicarbonate be instituted in all patients with rhabdomyolysis.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/67. Massive rhabdomyolysis and multiple organ dysfunction syndrome caused by leptospirosis.We report a case of leptospiral infection in a 63-year-old man who acquired the infection while swimming in canals and streams in hawaii. The patient's course was atypical in that he was anicteric and had no evidence of meningitis when he presented with fever, rapidly progressive and severe rhabdomyolysis, thrombocytopenia, acute renal failure, and respiratory distress syndrome. Although he recovered after a protracted illness, he required major life support, including mechanical ventilation and hemodialysis. Initial antimicrobial therapy was designed to cover major bacterial and atypical pathogens, including leptospires. An in-depth work-up for causes of this catastrophic illness confirmed acute leptospirosis. Although rare, leptospirosis is a potentially lethal infection classically associated with hepatitis, azotemia, and meningitis. Most patients experience self-limited illness, with fever, myalgias, and malaise followed by an immune-mediated aseptic meningitis. A small proportion develop shock and multiple organ dysfunction. Whereas myalgias are ubiquitous in leptospiral infection, and most patients show mildly elevated muscle enzymes, life-threatening rhabdomyolysis is rare. This atypical case is reported to urge clinicians to consider leptospirosis in the evaluation of a patient with cryptogenic sepsis who develops multiple organ dysfunction associated with rhabdomyolysis. Appropriate antimicrobial therapy, with penicillin or doxycycline, can be life-saving.- - - - - - - - - - ranking = 1.5keywords = life (Clic here for more details about this article) |
3/67. A case of cytophagic histiocytic panniculitis associated with exertional rhabdomyolysis.An 18-year-old man who suffered from panniculitis involving the entire left lower limb after exertional rhabdomyolysis is reported. A high fever (>39 degrees C) and leukocytosis (>20,000/microL) persisted for 1 week, and his general status deteriorated rapidly into pre-disseminated intravascular coagulation, complicated by pleural effusion and prolonged clotting time. His condition was dramatically improved by steroid pulse therapy and he has remained in good health for the 20 months since discharge. Histologic examination of subcutaneous tissue from the swollen left lower limb revealed pleomorphic small, medium or large lymphocytes, macrophages and neutrophils infiltrating the edematous subcutaneous adipose tissue in a lobular panniculitis-like pattern. The majority of inflammatory cells were T lymphocytes, with equal proportions of CD4 and CD8 cells. As polymerase chain reaction did not show bands suggesting T cell receptor gamma gene rearrangement, the proliferation of T lymphocytes was considered to be polyclonal. The T lymphocytes also expressed Fas ligand, suggesting the involvement of Fas-mediated cytotoxicity. This case may represent a new category of cytophagic histiocytic panniculitis induced by exertional rhabdomyolysis.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
4/67. Serious adverse events attributed to nevirapine regimens for postexposure prophylaxis after hiv exposures--worldwide, 1997-2000.In September 2000, two instances of life-threatening hepatotoxicity were reported in health-care workers taking nevirapine (NVP) for postexposure prophylaxis (PEP) after occupational human immunodeficiency virus (hiv) exposure. In one case, a 43-year-old female health-care worker required liver transplantation after developing fulminant hepatitis and end-stage hepatic failure while taking NVP, zidovudine, and lamivudine as PEP following a needlestick injury (1). In the second case, a 38-year-old male physician was hospitalized with life-threatening fulminant hepatitis while taking NVP, zidovudine, and lamivudine as PEP following a mucous membrane exposure. To characterize NVP-associated PEP toxicity, CDC and the food and Drug Administration (FDA) reviewed MedWatch reports of serious adverse events in persons taking NVP for PEP received by FDA (Figure 1). This report summarizes the results of that analysis and indicates that healthy persons taking abbreviated 4-week NVP regimens for PEP are at risk for serious adverse events. Clinicians should use recommended PEP guidelines and dosing instructions to reduce the risk for serious adverse events.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
5/67. Concurrent babesiosis and ehrlichiosis in an elderly host.An 85-year-old man, actively infected with babesia microti and ehrlichia chaffeensis, presented with fatigue and thrombocytopenia. He developed rhabdomyolysis and multiple organ failure, which led to death 6 days after initial presentation. To our knowledge, concurrent acute disease due to these 2 organisms has not been reported previously, although serologic studies have shown that some patients acquire both infections in life.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
6/67. diabetic ketoacidosis associated with recurrent pulmonary edema and rhabdomyolysis in a patient with Turner's syndrome.Turner's syndrome is a condition involving total or partial absence of one x chromosome and has been associated with a number of diseases including non insulin dependent diabetes mellitus, abnormalities of glucose metabolism and hypothreosis. There have been many case reports in which Turner's syndrome is associated with type 2 diabetes, but the association with type 1 diabetes and/or life threatening complications is very rare. We present an unusual case of a patient with Turner's syndrome who has type 1 diabetes and is complicated with ketoacidosis, severe acute and recurrent pulmonary edema and rhabdomyolysis.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
7/67. doxylamine overdose as a potential cause of rhabdomyolysis.doxylamine succinate, an over-the-counter antihistamine, is commonly used as a nighttime sleep aid in the short-term management of insomnia. It is also used in combination with antitussive and decongestant agents for the temporary relief of common cold symptoms. doxylamine is frequently involved in accidental and intentional overdoses. rhabdomyolysis and secondary acute renal failure are rare but potentially serious complications, making early recognition and treatment essential. With the large number of nonprescription antihistamines and sleep aids available to the general public, it is important to keep in mind that overdose is a potential problem. The complications associated with overdose of these medications are just as life threatening as those associated with prescription drugs. A high index of suspicion and evaluation of rhabdomyolysis is warranted in antihistamine toxicity. We report an observation of severe rhabdomyolysis associated with doxylamine overdose.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
8/67. Preventable rhabdomyolysis in prison inmates.Two inmates of our county jail suffered painful, life-threatening illness, and our taxpayers had considerable financial loss, as the result of self-inflicted rhabdomyolysis. We found reports of three similar cases from other states. Since prisoners are treated in a variety of medical facilities, this illness may be more common than reports indicate. It can be prevented by education and supervision of prisoners.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
9/67. rhabdomyolysis associated with varicella infection.Varicella infection is a common childhood disease that usually resolves without complications. However, children under 2 months of age, adolescents, some adults and immunocompromised individuals are at high risk of certain rare life-threatening complications. We report a case of primary varicella infection in an immunocompetent adult complicated by rhabdomyolysis. Recognition of this complication and aggressive fluid therapy with an antiviral agent helped to improve the outcome.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
10/67. Pathogenesis and treatment of rhabdomyolysis.PURPOSE: To provide clinicians in primary and acute care settings with information on the evaluation, diagnosis, and treatment of rhabdomyolysis. DATA SOURCES: Selected review articles from print and electronic sources, and a case study. CONCLUSIONS: rhabdomyolysis is a common disorder, which may result from a large variety of diseases, trauma, or toxic insults to skeletal muscle. It is caused by skeletal muscle injury and results in the release of muscle contents (i.e., myoglobin) into the plasma. Muscular, urinary, and general internal disturbances are the three areas where signs and symptoms occur. IMPLICATIONS FOR PRACTICE: Clinical signs and symptoms vary widely. Associated life-threatening complications include acute renal failure, cardiac arrhythmias and arrest, disseminated intravascular coagulation, and compartment syndrome. Early recognition and treatment in the acute phase of rhabdomyolysis are keys to successful outcomes and an excellent recovery.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
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