ro13-9904 and Rhabdomyolysis

We report a case of typhoid rhabdomyolysis with acute renal failure and acute pancreatitis in a 23-year-old Vietnamese male who was admitted to the intensive care unit with a 15-day history of fever followed by severe abdominal pain. On examination, the patient was febrile and his abdomen was diffusely tender. Serum creatinine was 533 micromol/L, pancreatic amylase 1800 U/L and lipase 900 U/L; the myoglobin blood level was high, which is associated with significant myoglobinuria. Blood, urine and stool culture yielded Salmonella enterica serovar typhi, which was sensitive to ceftriaxon, ampicillin and ciprofloxacin. Ceftriaxon was initiated for a total of 14 days. Subsequently, the patient maintained a good urine output with improved renal parameters and accordingly was discharged. In this report, we review the literature and discuss the pathogenesis of the disease thoroughly.

Topics: Acute Disease; Acute Kidney Injury; Adult; Anti-Bacterial Agents; Ceftriaxone; Humans; Male; Pancreatitis; Rhabdomyolysis; Salmonella typhi; Typhoid Fever; Young Adult

The presence of rhabdomyolysis secondary to multiple infections has been reported, predominantly viral, but also bacterial and fungal. It is well known that COVID-19 can present a wide variety of complications during the course of infection; however, the presence of rhabdomyolysis as an initial condition has not been reported so far. We report a case of rhabdomyolysis as an initial presentation in a patient diagnosed with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection.

Topics: Aged; Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Anticoagulants; Azithromycin; Betacoronavirus; Bicarbonates; Ceftriaxone; Coronavirus Infections; COVID-19; Cytochrome P-450 CYP3A Inhibitors; Enoxaparin; Enzyme Inhibitors; Fluid Therapy; Humans; Hydroxychloroquine; Lopinavir; Lung; Male; Pandemics; Pneumonia, Viral; Respiration, Artificial; Rhabdomyolysis; Ritonavir; SARS-CoV-2; Tomography, X-Ray Computed; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Combined Modality Therapy; Dental Prophylaxis; Diagnosis, Differential; Fasciotomy; Fever; Humans; Levofloxacin; Male; Mobility Limitation; Mouth; Muscle, Skeletal; Myalgia; Myositis; Rhabdomyolysis; Running; Streptococcus sanguis

A case of colchicine-induced rhabdomyolysis is reported. A 48 year old African-American male with history of hypertension and chronic gout on colchicine 0.6 mg daily presented with symptoms of a community acquired pneumonia. The patient was started on 500 mg of clarithromycin orally twice daily and represented to the emergency room after 3 days complaining of severe muscle pain. His liver panel showed elevations in the serum aminotransferases; AST 513 mU/ml (nl 15-41) and ALT 182 mU/ml (nl 17-63). His complete blood count showed an elevated white blood cell count of 18,800/ml (nl 4,000-10,000/ml). Urine analysis was positive for myoglobin with no red cells present. Serum creatine kinase (CK) was 22,996 mU/ml (nl 31-221) with a normal troponin I 0.18 (nl <0.4).Investigations confirmed the presence of rhabdomyolysis and discontinuation of colchicine and clarithromycin resulted in resolution of clinical and biochemical features of rhabdomyolysis. By hospital day four, his muscle soreness had improved markedly. His serum CK improved to 3,389 mU/ml (nl 31-221 mU/ml) and serum creatinine improved to 1.5 mg/dl (nl 0.8-1.2). On hospital day five, the patient was discharged on oral anti-hypertensive medication and a ten-day course of doxycycline. Metabolism of colchicine by the cytochrome P450 3A4 system has been previously described, but this is the first published report of colchicine associated rhabdomyolysis secondary to drug metabolism interactions with an antibiotic. A review of medications that are metabolized via the cytochrome 3A4 and A-SLAVED-LIVER (Amiodarone, Simvastatin, Lovastatin, Atorvastatin, Verapamil, Erythromycin, Diltiazem, cLarithromycin, Itraconazole, Voriconazole, colchicinE, Ritonavir) pneumonic was established.

Topics: Anti-Bacterial Agents; Ceftriaxone; Clarithromycin; Colchicine; Community-Acquired Infections; Doxycycline; Drug Interactions; Gout; Gout Suppressants; Humans; Male; Middle Aged; Pneumonia, Bacterial; Rhabdomyolysis; Treatment Outcome

The mortality and morbidity of salmonella infections is seriously underestimated. Salmonella myocarditis is an unusual complication of salmonella sepsis in adults. Cases that do occur may be associated with high morbidity and mortality. We present a rare case of salmonella myocarditis with multi-organ failure in a previously healthy young adult man who was brought to the emergency room with fever, diarrhea, shortness of breath, and altered sensorium, discovered to have acute pulmonary edema and respiratory compromise for which he was assisted with mechanical ventilation for 8 days. Blood culture grew Salmonella typhi. Biochemically he exhibited myocardial, hepatic, and muscular enzymatic surge with renal failure, features of rhabdomyolysis, and disseminated intravascular coagulation. The patient showed a progressive improvement on treatment with ceftriaxone for 2 weeks in addition to decongestive therapy. He was discharged in good condition afterward.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Ceftriaxone; Humans; Male; Multiple Organ Failure; Myocarditis; Pulmonary Edema; Rhabdomyolysis; Salmonella typhi; Treatment Outcome; Typhoid Fever

Topics: Adverse Drug Reaction Reporting Systems; Aged; Anemia, Hemolytic, Autoimmune; Anti-Infective Agents; Anticoagulants; Benzodiazepines; Caffeine; Canada; Ceftriaxone; Central Nervous System Stimulants; Child; Drug Interactions; Female; Humans; Ketolides; Middle Aged; Olanzapine; Peripheral Nervous System Diseases; Phytotherapy; Pulmonary Embolism; Rhabdomyolysis; Selective Serotonin Reuptake Inhibitors; Warfarin; Weight Loss