Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2023; 11(28): 6823-6830
Published online Oct 6, 2023. doi: 10.12998/wjcc.v11.i28.6823
Paraneoplastic myopathy-related rhabdomyolysis and pancreatic cancer: A case report and review of the literature
Andrea Costantini, Lucia Moletta, Elisa Sefora Pierobon, Simone Serafini, Michele Valmasoni, Cosimo Sperti
Andrea Costantini, Lucia Moletta, Elisa Sefora Pierobon, Michele Valmasoni, Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 1, University of Padua, Padua 35128, Italy
Simone Serafini, Cosimo Sperti, Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 2, University of Padua, Padua 35128, Italy
Author contributions: Costantini A, Moletta L, Pierobon ES and Serafini S contributed to the manuscript writing and editing, and data collection; Costantini A, Moletta L, Valmasoni M and Sperti C contributed to conceptualization and supervision; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lucia Moletta, MD, Doctor, Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 1, University of Padua, No. 2 Via Giustiniani, Padua 35128, Italy. lucia.moletta@unipd.it
Received: June 28, 2023
Peer-review started: June 28, 2023
First decision: August 10, 2023
Revised: August 22, 2023
Accepted: September 7, 2023
Article in press: September 7, 2023
Published online: October 6, 2023
Processing time: 88 Days and 19.9 Hours
Abstract
BACKGROUND

Rhabdomyolysis is a life-threatening condition, often leading to progressive renal failure and death. It is caused by destruction of skeletal muscle and the release of myoglobin and other intracellular contents into the circulation. The most frequent cause of this condition is “crush syndrome”, although several others have been described and paraneoplastic inflammatory myopathies associated with various types of cancer are repeatedly reported.

CASE SUMMARY

We describe a rare case of a patient with pancreatic cancer who developed rhabdomyolysis early on, possibly due to paraneoplastic myositis leading to acute renal failure and eventually to rapid death. A 78-year-old Caucasian woman was referred to our hospital for obstructive jaundice and weight loss due to a lesion in the pancreatic head. She presented increasingly severe renal insufficiency with anuria, a dramatic increase in creatine phosphokinase (36000 U/L, n.v. 20-180 U/L) and myoglobin (> 120000 μg/L, n.v. 12-70 μg/L). On clinical examination, the patient showed increasing pain in the lower limbs associated with muscle weakness which was severe enough to immobilize her. Paraneoplastic myopathy linked to the malignant lesion of the pancreatic head was suspected. The patient was treated with hemodialysis and intravenous methylprednisolone. Despite all the efforts to prepare the patient for surgery, her general condition rapidly deteriorated and she eventually died 30 d after hospital admission.

CONCLUSION

The possible causes of rhabdomyolysis in this patient with pancreatic cancer are discussed, the development of paraneoplastic myopathy being the most likely. Clinicians should bear in mind that these syndromes may become clinically manifest at any stage of the cancer course and their early diagnosis and treatment could improve the patient’s prognosis.

Keywords: Paraneoplastic myopathy; Rhabdomyolysis; Pancreatic cancer; Acute renal failure; Paraneoplastic myositis; Prognosis; Case report

Core Tip: Rhabdomyolysis is a life-threatening condition often leading to progressive renal failure and death. It is caused by destruction of skeletal muscle and the release of myoglobin and other intracellular contents into the circulation. There are several causes of this condition and paraneoplastic inflammatory myopathies associated with various types of cancer are reported. We describe the case of a patient with pancreatic cancer who developed rhabdomyolysis early on, possibly due to paraneoplastic myositis. The possible causes of rhabdomyolysis in patients with pancreatic cancer are discussed, paraneoplastic myopathy being the most likely.