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Rhabdomyolysis is a rare adverse effect reported with daptomy-cin use. Here we report the first case of creatinine phosphokinase (CPK) elevation with rhabdomyolysis developing during the co-administration of daptomycin and pegylated interferon a-2b and ribavirin. We describe the case of a patient with a history of intravenous drug abuse and hepatitis C admitted to our division because of fever and pain in the right gluteal region. The patient's general condition was poor, but his physical examination was unremarkable, except for the presence of a right gluteal abscess. The patient had been taking pegylated interferon a-2b and ribavirin for 5 months without reporting side effects. On admission, liver function tests were within normal limits, serum CPK level was slightly elevated (518 U/L; normal values 39 –308 U/L), lactate dehydrogenase (LDH) was 580 U/L (normal values 240–480 U/L), serum creatinine was 1.6 mg/dL and estimated CL CR was 124.8 mL/min. The white blood cell (WBC) count showed neutrophil leucocytosis (WBC 11 580 cells/mm 3 , 87.1% neutrophils) and a low platelet count (72 000 cells/mm 3). All other laboratory findings were within normal limits. Hepatitis C virus (HCV) RNA viral load was undetectable. Blood cultures were performed. The patient was started on empirical antibiotic therapy with levofloxacin (750 mg once daily intravenously) and piperacillin/ tazobactam (4.5 g every 6 h intravenously). Due to lack of improvement of symptoms and fever after 48 h, levofloxacin was switched to daptomycin (500 mg daily intravenously). The second dose was administered, by mistake, 4 h before it should have been. Five days after admission, after only two doses of daptomycin, the patient suddenly complained of weakness and diffuse aches in the proximal thighs and arms. Serum CPK levels were very high (12 933 U/L) and further elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT), 371 and 67 IU/L, respectively, were also noted. A urine drug screen was performed to rule out damage related to illicit substance use, and the results were negative. Blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). Suspecting daptomycin-induced rhabdomyolysis, treatment was switched to linezolid (600 mg twice daily intravenously) and meropenem (1 g every 8 h intravenously). The patient was hydrated (2 L/day) to preserve renal function, and this was strictly monitored throughout the course; urinalysis was positive for myoglobin. Although daptomycin had been interrupted, CPK levels and AST/ALT levels continued to increase for 5 days after and on the …

Rhabdomyolysis associated with the co-administration of daptomycin and pegylated interferon -2b and ribavirin in a patient with hepatitis C