Rhabdomyolysis associated with cytomegalovirus infection in kidney transplant recipients

Abstract

Rhabdomyolysis is a pathological syndrome caused by skeletal muscle cell damage that affects the integrity of the cellular membrane and leads to the release of toxic intracellular constituents into the bloodstream. Although cytomegalovirus (CMV) has rarely been reported as a cause of rhabdomyolysis, CMV infection could be considered as a possible cause because of its clinical significance in kidney transplant recipients (KTRs). We report 2 cases of rhabdomyolysis associated with CMV infection in KTRs. A 64-year-old woman (Case 1) and a 65-year-old man (Case 2), who had each received a kidney from a living unrelated donor, were admitted with complaints of weakness in both legs and myalgia. Laboratory findings revealed highly increased creatine phosphokinase and myoglobinuria. In both cases, no recent alterations of medications had occurred, and other causes of rhabdomyolysis--such as trauma, alcohol, drugs, and electrolyte abnormalities - were excluded. CMV pp65 antigen was positive, and patients were diagnosed with rhabdomyolysis associated with CMV infection. Both patients recovered without complications after ganciclovir treatment. In conclusion, CMV infection should be considered as a possible cause of rhabdomyolysis in KTRs.

Secondary myopathy due to systemic diseases

“…Risk factors for developing rhabdomyolysis include myalgia, arterial hypertension, and acute renal failure . More rarely rhabdomyolysis may be triggered by infections with influenza‐A , influenza‐B , parainfluenza , herpes‐6 , varicella zoster , cytomegaly virus (CMV) , coronavirus‐NL63 , chikungunya , Alkhurma hemorrhagic fever virus , or HIV‐1 . Rhabdomyolysis in dengue fever infections can be life‐threatening in some cases .…”

Coincidence of late‐onset cytomegalovirus‐induced myositis and gastritis in a pediatric renal transplant recipient

“…Viral myositis may be secondary to viral transmission from the donor, to reactivation, or a de novo infection in immunocompromised patients . Although CMV has rarely been reported as a cause of myositis or rhabdomyolysis in renal transplant recipients, CMV infection should be considered as a possible cause of myositis and rhabdomyolysis .…”

“…In renal transplant recipients, CMV disease can present with various manifestations, including CMV syndrome, pneumonia, gastrointestinal (GI) disease, hepatitis, encephalitis, nephritis, myocarditis, and pancreatitis . Rarely, this disease can also manifest with muscle damage, such as myositis and rhabdomyolysis . We report a case of the coincidence of myositis and gastritis associated with CMV in a child with a renal transplant, which developed after 6 months of post‐transplant valganciclovir prophylaxis.…”

Insuficiencia renal aguda inducida por rabdomiolisis

“…Existen informes de casos de rabdomiolisis asociados a infecciones: influenza A y B, virus Coxsackie, virus de Epstein-Barr, VIH, Legionella, Streptococcus pyogenes, Staphylococcus aureus y citomegalovirus (24). En la reciente pandemia de influenza H1N1 se publicaron artículos según los cuales 62 % de los pacientes con neumonía y falla respiratoria tenían elevación de la creatina-fosfoquinasa (CPK) (18,23).…”