Context:Rhabdomyolysis is a serious clinical syndrome that results from damage to skeletal muscles. Common causes include drugs, crush injuries, seizures, heat, exertion, and infection. Viral infections, particularly Influenza A, have been recognized as a cause of rhabdomyolysis.Case Report:Our report describes a 58-year-old male who presented with viral pneumonia secondary to Influenza A virus infection. His hospital course was complicated by acute renal failure secondary to rhabdomyolysis, which was attributed to an overwhelming viremia. We discuss the differential diagnosis of rhabdomyolysis and review the literature for cases of Influenza A-related rhabdomyolysis. We also discuss the proposed mechanisms for the condition.Conclusion:The scope of clinical manifestations of Influenza A infection extends beyond pulmonary syndromes. Rhabdomyolysis is being increasingly recognized as a complication of Influenza A infection with considerable morbidity and mortality.

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Context:Rivaroxaban is a direct factor Xa inhibitor approved for the prevention of thromboembolism. Drug induced liver injury has been increasingly reported with rivaroxaban recently, but actual liver failure has not been reported.Case Report:We present a case report on the probable occurrence of acute liver failure with rivaroxaban therapy. An 89 year old woman with history of atrial fibrillation was hospitalized for biventricular congestive heart failure with passive congestion of liver, which responded to furosemide. She was discharged home on rivaroxaban for prevention of thrombo-embolism. Liver function tests upon discharge returned to almost normal range. One week later, she presented with abdominal pain and was found to have highly elevated liver enzymes, elevated bilirubin, and an abnormal coagulation profile. A day later, she developed hepatic encephalopathy, suggesting liver failure.Conclusion:Liver enzymes declined rapidly with the discontinuation of all of her medications, however patient died because of multi-organ failure. The causality assessment in this patient was “probable” with rivaroxaban.

Context:Ventricular standstill (VS) is an uncommon electrophysiological phenomenon and usually manifests as syncope. Rarely has a case been reported where the patient has been totally asymptomatic, and it has resolved spontaneously.Case Report:We report a case of complete VS and high-degree atrioventricular (AV) block in a 50-year-old female, who was admitted for nausea, vomiting, and chest pain. The patient never had a syncopal episode, even though she was in VS for more than 10 s.Conclusion:Such degree of conduction abnormality without any syncope has not been reported so far. Her electrophysiological abnormality was attributed to profound vagotonic effect and was treated with a permanent pacemaker.

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