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Case Report
A case of rhabdomyolysis with rigors
1 College of Medicine and Life Sciences, University of Toledo Medical Center, Toledo, OH, USA
2 Internal Medicine Resident, College of Medicine and Life Sciences, University of Toledo Medical Center, Toledo, OH, USA
Address correspondence to:
Basil Akpunonu
MD, 3000 Arlington Avenue, MS 1186, Toledo, OH 43614,
USA
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Article ID: 101321Z01EB2022
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Bliss E, Vellani SD, Spencer C, Federman D, Khuder S, Akpunonu B. A case of rhabdomyolysis with rigors. Int J Case Rep Images 2022;13(2):26–30.ABSTRACT
Introduction: Rhabdomyolysis is a potential life-threatening condition caused by extensive skeletal muscle breakdown with leakage of toxic muscle contents into the circulation. The most dreaded complication is acute renal failure caused by toxic effects of myoglobin in the kidneys. The causes of rhabdomyolysis are classified into traumatic, non-traumatic exertional, and non-traumatic rhabdomyolysis. The pathophysiologic hallmark of rhabdomyolysis regardless of etiology is increased free ionized calcium due to cellular energy depletion (ATP) or direct plasma membrane rupture and consequent intensified muscle contractility, mitochondrial dysfunction, and production of oxygen radicals.
Case Report: We report a case of a middle-aged black woman with rhabdomyolysis that was caused by intense shivering chills, and rigor from pneumonitis. She had no personal or family history of muscle disorder and was admitted to the hospital after a weeklong history of upper and lower respiratory symptoms that led to the worse shivering and shaking chills she ever had. She was noted to have elevated creatine phosphokinase (CPK) of 200,000 uL (26–192 uL) and creatinine level of 5.52 (0.81–1.2 mg/dL). She was started on intravenous fluid with half-isotonic saline (0.45%) or 77 mmol/L sodium, 75 mmol/L sodium bicarbonate, and hemodialysis with progressive improvement in kidney function that took up to seven weeks to full recovery.
Conclusion: Shivering and shaking chills from respiratory infection can cause rhabdomyolysis with severe muscle damage and renal failure in a patient with no known underlying muscular-skeletal disorder condition but has good recovery with fluid management and hemodialysis. Renal function has returned back to normal.
Keywords: Dialysis, Renal insufficiency, Rhabdomyolysis, Shivering
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Acknowledgments
Thank you to Brenda Joyce for her administrative support and assistance with the submission of this case report.
Author ContributionsEmily Bliss - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Shahnaz D Vellani - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Caleb Spencer - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Douglas Federman - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sadik Khuder - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Basil Akpunonu - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Emily Bliss et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
