A 6-Year-Old Girl with Recurrent Rhabdomyolysis

Abstract

A 6-year-old caucasian girl was observed in the emergency department for fever, odynophagia, anorexia and myalgia. She had past history of elevated creatine kinase (CK) and toe walking till the age of 2, with intermittent CK elevation, and otherwise normal physical examination and basic etiological investigations. She had no other relevant personal or family history, and a normal newborn expanded metabolic screening. At physical examination she was well-appearing but febrile (temperature of 39.3ºC), with dry lips, enanthema, conjunctival hyperemia, bilateral cervical adenopathies and muscular pain. Blood tests revealed mild anemia (hemoglobin level, 11.4 g/dL), and elevation of white blood cell count (12530/uL with 47.7% lymphocytes), CK (2196 U/L), lactate dehydrogenase (649 U/L) and C-reactive protein (1,97 mg/dl). Liver enzymes, urea and creatinine values were normal, as well as urine biochemistry. A rapid Streptococcus pyogenes diagnostic test was negative. Blood serol