Rhabdomyolysis and influenza a (H3N2) infection: A case report

Influenza causes respiratory tract diseases with acute respiratory distress syndrome (ARDS) as the leading and most severe life threatening complication. In terms of early diagnosis, extrapulmonary complications are less common, but clinically a significant problem [1]. In the territory of Vojvodina, influenza occurs in epidemic forms, usually in the winter months. The most common cause is the virus Influenza A. In the season 2014/2015, the dominant type was A/H3N2. Pulmonary complications were the most common complications, and also the most common cause of death [2, 3]. However, we are witnessing the appearance of other rare and often unrecognized, life threatening complications. Rhabdomyolysis (RM) is the destruction of skeletal muscle followed by the release of intracellular myofibrils into the bloodstream and extracellular fluid. Clinical manifestations vary, from asymptomatic to life threatening conditions, such as acute renal failure and disseminated intravascular coagulation [4]. Although myositis is the most common symptom of the flu syndrome, the development of RM is rare, and it is more likely to occur in individuals with a genetic predisposition. The aim of this paper is to highlight RM as a potentially life threatening complication of influenza. Summary Introduction. Extrapulmonary complications of influenza infections are often unrecognized. The aim of this paper is to point to rhabdomyolysis as a potentially life threatening complication of influenza. Case Report. A month after the onset of influenza complicated by bronchopneumonia, the general condition of a nineteen year old female deteriorated with development of progressive muscle weakness and dark-colored urine. Despite intensive hydration and antibiotic therapy, her condition got worse, laboratory findings showed pancytopenia, hypoalbuminemia and creatine phosphokinase about 1000 times higher than normal. Influenza A H3N2 was confirmed by polymerase chain reaction analysis of the throat swab sample. Electromyoneurography showed severe acute polyneuropathy of muscles innervated by perineal nerve and signs of polymyositis; pathohistological examination of gastrocnemius muscle biopsy sample confirmed chronic myositis with necrotic neurogenic atrophy. In spite of intense hydration, the patient’s status continued deteriorating, so methylprednisolone was administered. Six weeks later, the patient was discharged in a good general condition, with blood test results within reference ranges, with weakness of foot dorsiflexors and tilting of the pelvis to the left during verticalization. Conclusion. Rhabdomyolysis caused by influenza-A is on the increase, and given the degree of morbidity and mortality, thorough assessment of patients is necessary.