Rhabdomyolysis associated with Crohn's disease.

Chiba, Mitsuro; Igarashi, K.; Ohta, Hiromasa; Ohtaka, Michiro; Arakawa, Hiromichi; Masamune, Osamu

doi:10.2169/internalmedicine1962.26.255

Cited by 10 publications

(4 citation statements)

References 18 publications

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“…8 Several cases of Crohn's disease associated with muscle symptoms or hyper CPK-emia have been reported. 14-16 Some proved to be caused by abscess in psoas muscle or by malnutrition-induced hypopotassemia, [15][16][17][18] but the etiological by decreased serum phosphorous and potassium concentrations. Our patient, however, showed normal serum phosphorus and potassium concentration throughout her clinical course, quite different to findings in patients with refeeding syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Although the number of patients with Crohn's disease who have high serum CPK levels may be small, [14][15][16] monitoring of serum CPK levels may be necessary for the early detection of possible damage to skeletal muscles when nutritional treatment with an elemental diet is initiated in patients with a long-standing poor nutritional state.…”

Section: Discussionmentioning

confidence: 99%

“…In response to this change, prompt alleviation of her muscle factors in other patients were not known. Although some patients with Crohn's disease who manifested high CPK levels had received nutritional therapy with an elemental diet, 15 the causative role of the elemental diet in the hyper CPK-emia remains unclear. In our present patient both pyruvate and lactate levels in plasma during the forearm muscle contraction test under ischemia-induced anaerobic conditions were lower than those in normal individuals, 13 suggesting the decreased activity of an enzyme or enzymes which catabolize glycogen into pyruvate and lactate.…”

Section: Case Reportmentioning

confidence: 99%

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Severe muscle damage induced by high carbohydrate intake from elemental diet in a patient with Crohn's disease

Waki

Kawanami

Kanda

et al. 1998

Journal of Gastroenterology

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Crohn's disease is associated with complications in multiple organs. However, there are very few reported cases of patients with Crohn's disease with muscle symptoms and/or high serum creatine phospho-kinase (CPK) levels. We report here a patient with Crohn's disease who experienced skeletal muscle damage with extremely high serum CPK level during treatment with an elemental diet. The non-parenteral administration of large amounts of carbohydrate and limited glycogen degradation capability may be a possible causative mechanism for this elemental diet-induced muscle damage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

See 1 more Smart Citation

Severe muscle damage induced by high carbohydrate intake from elemental diet in a patient with Crohn's disease

Waki

Kawanami

Kanda

et al. 1998

Journal of Gastroenterology

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“…The timing of the onset of myositis has been shown to vary widely among patients with IBD [10-12]. Only a small number of cases of rhabdomyolysis in association with CD have been reported, of which the subclinical presentation is more common than the acute presentation [13]. Most of these were caused by hypokalemia associated with severe IBD, and only one case report describes probable immune pathogenesis [10,14-16].…”

Section: Introductionmentioning

confidence: 99%

The concurrent association of inflammatory polymyositis and Crohn’s ileo-colitis in a Sri Lankan man: a case report of a rare association and literature review

et al. 2014

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BackgroundCrohn’s disease is a relapsing, systemic inflammatory disease affecting the gastrointestinal tract with associated extraintestinal manifestations and immune disorders. Among the few cases reported, the association of Crohn’s disease with polymyositis varies in its complexity and severity. We report here the first known case of inflammatory polymyositis leading to rhabdomyolysis in a male patient diagnosed with Crohn’s ileocolitis.Case presentationA 42-year-old previously healthy man presented with acute polymyositis leading to rhabdomyolysis. The acute nature of the illness raised the suspicion of an infective, toxic, or metabolic insult, which was excluded during further investigations. Prolonged low-grade fever and raised inflammatory markers led to the suspicion of inflammatory polymyositis, which was confirmed by electromyography and muscle histology. In the absence of an infective cause, the concurrent association of prolonged diarrhea containing blood and mucous after recovery from an acute phase of myositis proved a diagnostic challenge. Ileocolonoscopy findings of extensive aphthous ulceration with skip lesions extending to the terminal ileum, and histology showing polymorph infiltration of the lamina propria, transmural involvement, and micro abscess formation was suggestive of Crohn’s disease. Sensory motor axonal peripheral neuropathy, which is another rare association of inflammatory bowel disease, was also present.ConclusionAn unrecognized genetic predisposition or altered gut permeability causing disruption of the gut immune barrier triggering an immune response against skeletal muscles may have contributed to this unique association. Both polymyositis and Crohn’s ileocolitis responded well to corticosteroids and azathioprine, which is supportive of their immune pathogenesis. Myositis can be considered to be a rare extraintestinal manifestation of Crohn’s disease and can be used in the differential diagnosis of corticosteroid or hypokalemia-induced myopathy in Crohn’s disease.

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Rhabdomyolysis: A review

2002

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Rhabdomyolysis, a syndrome of skeletal muscle breakdown with leakage of muscle contents, is frequently accompanied by myoglobinuria, and if sufficiently severe, acute renal failure with potentially life-threatening metabolic derangements may ensue. A diverse spectrum of inherited and acquired disorders affecting muscle membranes, membrane ion channels, and muscle energy supply causes rhabdomyolysis. Common final pathophysiological mechanisms among these causes of rhabdomyolysis include an uncontrolled rise in free intracellular calcium and activation of calcium-dependent proteases, which lead to destruction of myofibrils and lysosomal digestion of muscle fiber contents. Recent advances in molecular genetics and muscle enzyme histochemistry may enable a specific metabolic diagnosis in many patients with idiopathic recurrent rhabdomyolysis.

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Rhabdomyolysis associated with Crohn's disease.

Cited by 10 publications

References 18 publications

Severe muscle damage induced by high carbohydrate intake from elemental diet in a patient with Crohn's disease

Severe muscle damage induced by high carbohydrate intake from elemental diet in a patient with Crohn's disease

The concurrent association of inflammatory polymyositis and Crohn’s ileo-colitis in a Sri Lankan man: a case report of a rare association and literature review

Rhabdomyolysis: A review

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