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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 2  |  Issue : 3  |  Page : 315
Severe rhabdomyolysis associated in meningococcemia


Department of Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India

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Date of Web Publication17-Aug-2010
 

How to cite this article:
Sharma V, Agarwal MP, Giri S. Severe rhabdomyolysis associated in meningococcemia. J Global Infect Dis 2010;2:315

How to cite this URL:
Sharma V, Agarwal MP, Giri S. Severe rhabdomyolysis associated in meningococcemia. J Global Infect Dis [serial online] 2010 [cited 2019 Jun 16];2:315. Available from: http://www.jgid.org/text.asp?2010/2/3/315/68546


Sir,

We read with interest the article on rhabdomyolysis secondary to staphylococcal endocarditis. [1] We would like to share our experience with a case of severe rhabdomyolysis secondary to meningococcemia.

A 22-year-old male, labourer by occupation, presented with a 2-day history of fever. The fever was abrupt in onset and was associated with chills and rigors. The patient had also developed a purpuric rash and altered sensorium for 1 day. There was no history of any seizures. At the time of presentation, the patient was unconscious and in hypotension (blood pressure of 70/48 mmHg). He had tachycardia (pulse 118/min, regular) and was tachypneic (RR 28/min). He had a purpuric rash over his extremities [Figure 1]. He also had neck rigidity, but moved all limbs to pain, and his plantars were flexor. Fundus revealed no papilledema. In view of the presentation, a working diagnosis of meningococcemia with meningitis was made and the patient was managed with volume resuscitation, intravenous ceftriaxone and hydrocortisone. His blood pressure improved initially. Noncontrast computed tomography (CT) of the head was unremarkable. A lumbar puncture was performed and the cerebrospinal fluid revealed protein of 112 mg/dL, sugar of 12 mg/dL, cells 2,300 with 95% polymorphs and gram stain showing gram-negative diplococcici. Latex agglutination test was positive for Group A meningococcal infection. Over his stay, his urine output was low (100 mL over 12 h) and urine dipstick showed presence of blood. His renal functions were deranged (serum creatinine 4.3 ng/mL, blood urea 242 mg/dL, serum Na+ 134, serum K 5.5 meq/L). Serum creatine kinase was 32,220 U/L. Other investigations revealed Hb 11.8 gm%, TLC 23,000, platelet count 48,000/΅L, serum bilirubin 1.9, SGPT 96 U/L. Urine myoglobin was not performed. Although the patient was planned for hemodialysis, he developed hypotension and, in spite of all measures, including vasopressor support, the patient died.
Figure 1 :Photograph showing purpuric rash of meningococcemia

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The above case highlights the presence of severe rhabdomyolysis in case of bacterial septicaemia secondary to meningococcal infection. Although rhabdomyolysis has been reported with meningococcal infection, we are not aware of any report of renal failure secondary to rhabdomyolysis with meningococcemia. [2],[3] Rhabdomyolysis can therefore be another cause of acute renal shutdown in sepsis apart from septic acute tubular necrosis. Clinicians should be aware of this possibility and appropriate management, including renal replacement, should be initiated when indicated.

 
   References Top

1.Bandi S, Chikermane A. Rhabdomyolysis in a child secondary to Staphylococcus aureus endocarditis. J Global Infect Dis 2009;1:146-8.  Back to cited text no. 1  [PUBMED]  Medknow Journal  
2.Chamberlain MC. Rhabdomyolysis in children: a 3-year retrospective study. Pediatr Neurol 1991;7:226-8.  Back to cited text no. 2  [PUBMED]    
3.Morano Amado LE, Vαzquez Alvarez OM, Braρas Fernαndez F, Sesma Sαnchez P. Rhabdomyolysis associated with Neisseria meningitidis infection. An Med Interna 1990;7:546-7.  Back to cited text no. 3      

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Correspondence Address:
Vishal Sharma
Department of Medicine, University College of Medical Sciences and GTB Hospital, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.68546

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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
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