Background Rhabdomyolysis, the breakdown of skeletal muscles following an insult or injury, has been established as a possible complication of SARS-CoV-2 infection. Despite being highly effective in preventing COVID-19-related morbidity and mortality, several cases of COVID-19 mRNA vaccination-induced rhabdomyolysis have been identified. We provide the second description of a pediatric case of severe rhabdomyolysis presenting after COVID-19 mRNA vaccination. Case: diagnosis/treatment A 16-year-old male reported to the emergency department with a 2-day history of bilateral upper extremity myalgias and dark urine 2 days after his first dose of COVID-19 vaccine (Pfizer-BioNtech). The initial blood work showed an elevated creatinine kinase (CK) of 141,300 units/L and a normal creatinine of 69 umol/L. The urinalysis was suggestive of myoglobinuria, with the microscopy revealing blood but no red blood cells. Rhabdomyolysis was diagnosed, and the patient was admitted for intravenous hydration, alkalinization of urine, and monitoring of kidney function. CK levels declined with supportive care, while his kidney function remained normal, and no electrolyte abnormalities developed. The patient was discharged 5 days after admission as his symptoms resolved. Conclusion While vaccination is the safest and most effective way to prevent morbidity from COVID-19, clinicians should be aware that rhabdomyolysis could be a rare but treatable adverse event of COVID-19 mRNA vaccination. With early recognition and diagnosis and supportive management, rhabdomyolysis has an excellent prognosis.
C rohn disease (CD) and ulcerative colitis (UC) are intestinal inflammatory conditions increasingly diagnosed in childhood. Complications include local abdominal and more systemic problems; however, the link to the underlying inflammatory bowel disease (IBD) is not always evident. Conversely, however, not all abdominal symptomatology in a patient with IBD is necessarily the result of the condition itself. We report on a teenage girl previously diagnosed as having UC, who presented with cyclic episodes of peritoneal symptoms initially attributed to potential microperforations from misdiagnosed CD. Laparoscopic examination and specimen confirmed diagnosis of serosal endometriosis.A teenage girl was hospitalized 3 times during a 9-month period for recurrent episodes of severe, sudden-onset abdominal pain with peritoneal signs (Table 1). Her medical history was significant for a diagnosis of IBD in summer 2007, at 14 years old. Colonoscopy had revealed pancolitis with relative rectal sparing and a normal terminal ileum. She was diagnosed as having UC based on histology and serologic markers, and responded to prednisone followed by 6-mercaptopurine. Within 5 months of diagnosis, she had her first menstruation.The patient was hospitalized when she presented 1 year later with fever, periumbilical pain, vomiting, abdominal tenderness, and guarding. (Table 1). She developed Bacteroides fragilis bacteremia, attributed to intestinal microperforation, and was managed with intravenous (IV) antibiotics. One month later, she returned with similar, although less severe, abdominal pain. She was again managed conservatively. A magnetic resonance enterography revealed a tubular, chronically inflamed sigmoid colon.Four months later, the patient was again hospitalized for vomiting, severe abdominal pain, and constipation, and responded to IV antibiotics and corticosteroids. In early 2009, colonoscopy demonstrated mild chronic colitis with normal ileum; however, upper endoscopy was normal. A capsule endoscopy revealed a normal small bowel. Because history revealed irregular menses
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