A 47 year-old woman, on hemodialysis via an arteriovenous (AV) fistula, was assessed for severe dyspnea and presyncope secondary to pulmonary hypertension. Right heart catheterization confirmed a mean pulmonary arterial pressure of 85 mm Hg. She had a normal wedge pressure. Investigations revealed that the total high cardiac output AV fistula, 8.3 L/min, resulted in pulmonary arteropathy and increased pulmonary vascular resistance at 674 dyne.sec.cm-5. The AV fistula was banded and Sildenafil was prescribed, which resulted in improvement of pulmonary hypertension within one week.
SummaryWe present a unique case of atraumatic rhabdomyolysis and four-limb compartment syndrome. Edema and inflammation associated with rhabdomyolysis, was further exacerbated by aggressive saline resuscitation. This resulted in raised compartment pressures and necessitated four-limb fasciotomy. The cause of rhabdomyolysis was most likely multifactorial including systemic capillary leak syndrome seizure, illicit drug use (crack cocaine and methamphetamine) and the prescription medication, mirtazapine.
RésuméNous présentons ici un cas exceptionnel de rhabdomyolyse atraumatique accompagnée d'un syndrome des loges aux quatre membres. L'oedème et l'inflammation associés à la rhabdomyolyse ayant été exacerbés par une réanimation liquidienne agressive, il en est résulté une augmentation de la pression dans les loges et il a fallu procéder à une aponévrotomie aux quatre membres. La rhabdomyolyse a été très probablement causée par plusieurs facteurs, dont une crise systémique d'un syndrome de fuite capillaire et l'usage illicite de drogues (cocaïne épurée ou crack, méthamphétamine) jumelé au médicament prescrit, la mirtazapine.
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