Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2019; 7(24): 4218-4225
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4218
Community-acquired pneumonia complicated by rhabdomyolysis: A clinical analysis of 11 cases
Bo Zhao, Rui Zheng
Bo Zhao, Rui Zheng, Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Author contributions: Zhao B collected and analyzed the patients’ medical data. Zhao B and Zheng R wrote and revised the manuscript. Zheng R critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Shengjing Hospital of China Medical University (Ethics KYCS2019009).
Informed consent statement: This retrospective study mainly analyzed the results of laboratory examinations and disease outcomes obtained from the patients’ medical records and did not involve patients’ personal information. Exemption from obtaining informed consent from patients was approved by the Ethics Committee.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rui Zheng, MD, PhD, Doctor, Professor, Teacher, Department of Respiratory Medicine, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China. zhengr@sj-hospital.org
Telephone: +86-24-9661521211
Received: June 5, 2019
Peer-review started: June 6, 2019
First decision: September 9, 2019
Revised: October 12, 2019
Accepted: October 30, 2019
Article in press: October 30, 2019
Published online: December 26, 2019
Processing time: 203 Days and 22.4 Hours
Abstract
BACKGROUND

In clinical practice, community-acquired pneumonia (CAP) can be complicated by rhabdomyolysis (RM), and RM symptoms are mild and easily missed during diagnosis. Moreover, available data on RM induced by CAP are mainly from case reports. Due to the relatively low incidence of CAP-induced RM, more systematic studies are required to understand the characteristics of CAP-induced RM to improve its diagnosis and treatment.

AIM

To investigate the clinical characteristics of patients with CAP-induced RM.

METHODS

This was a retrospective study of 11 patients with CAP-induced RM. Baseline characteristics, diagnostic work-up, and laboratory test results were summarized and compared with those of 48 patients with exercise-induced RM admitted during the same period.

RESULTS

CAP-induced RM was more common in men, and affected older patients compared to those with exercise-induced RM. However, the average age of the patients in this study was lower than the age of peak incidence of CAP in adults in China. The major clinical manifestations were high fever and respiratory symptoms. RM symptoms were mild and often overlooked. Patients with CAP-induced RM had elevated inflammatory parameters, respiratory alkalosis, relatively low serum potassium levels and often had abnormalities in hepatic and renal function and cardiac enzymes. Compared with the exercise group, the pneumonia group had lower levels of creatine kinase and myoglobin, a higher incidence of acute kidney injury, and worse renal function and prognosis. Adverse events were mainly related to the severity of CAP.

CONCLUSION

CAP-induced RM has different clinical characteristics from those of exercise-induced RM. Early detection and treatment could reduce complications and consequently shorten the treatment course.

Keywords: Community-acquired pneumonia; Rhabdomyolysis; Exercise; Acute kidney injury

Core tip: In clinical practice, community-acquired pneumonia (CAP) can induce rhabdomyolysis (RM), and RM symptoms are mild and easily missed during diagnosis. Moreover, available data on RM are mainly from case reports, and systematic research data are lacking. We retrospectively reviewed the clinical characteristics, test parameters, and prognosis of patients with CAP-induced RM. The results were compared with strenuous exercise-induced RM, a common cause of RM requiring admission. This study aimed to determine the characteristics of RM induced by CAP in an attempt to improve its diagnosis and treatment.