Recurrent Viral-Induced Compartment Syndrome

Abstract

This is the first reported case of recurrent rhabdomyolysis and compartment syndrome as a complication of viral myositis. This case highlights the importance of maintaining a high index of suspicion for compartment syndrome in the child with viral myositis.

Rhabdomyolysis associated with influenza A/H1N1 2009 infection in a pediatric patient

“…The remaining one case was an immunocompetent 8‐year‐old girl with recurrent histories of rhabdomyolysis and bilateral thigh compartment syndrome. Compartment syndrome is rare but a limb‐threatening complication associated with influenza A H1/N1 2009 15 . The present case was demonstrated rhabdomyolysis with myoglobinuria, hyperkalemia, cardiac dysfunction and compartment syndrome that arose during convalescence from influenza A/H1N1 2009 infection.…”

“…Compartment syndrome is rare but a limb-threatening complication associated with influenza A H1/N1 2009. 15 The present case was demonstrated rhabdomyolysis with myoglobinuria, hyperkalemia, cardiac dysfunction and compartment syndrome that arose during convalescence from influenza A/H1N1 2009 infection. Our patient did not manifest severe pulmonary complications from the virus.…”

Rhabdomyolysis Associated with Parainfluenza Virus

“…The efficacy of antivirals such as neuraminidase inhibitors in rhabdomyolysis caused by influenza is unknown. In addition, recurrent rhabdomyolysis and compartment syndrome, first precipitated by parainfluenza and on a second occasion by influenza, have been described in a child unvaccinated for influenza [15]. Recurrent rhabdomyolysis associated with influenza has been reported in 10 children [12].…”

Elevation of creatine kinase is associated with worse outcomes in 2009 pH1N1 influenza A infection

“…Although some isolated case reports of pH1N1-associated rhabdomyolysis have been published [18][19][20][21][22], uncertainty still remains regarding the clinical implications of elevated creatine kinase levels. While the association of elevated CK with requirement for RRT has been documented at CK level around 11,000 UI/L in several pH1N1 case reports [23,24], others have failed to demonstrate a need for RRT, even at levels of CK of 16,000 UI/L and above [22,25,26]. A series of case reports showed elevated levels (1,000-5,000 UI/L) of CK in severe presentations of pH1N1 infection [27], and one case report showed AKI due to pH1N1-induced rhabdomyolysis (with CK levels above 40,000 UI/L) [28].…”