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
ARTICLE HIGHLIGHTS
Research background

In clinical practice, rhabdomyolysis (RM) can be caused by community-acquired pneumonia (CAP), which has different clinical characteristics from RM induced by exercise. RM symptoms are mild and can be easily missed during diagnosis. Further studies are needed to determine the characteristics of CAP-induced RM to improve its diagnosis and treatment.

Research motivation

Cases of RM secondary to CAP have been reported, but systematic research data are not available. We believe that some patients with CAP-induced RM have been missed or misdiagnosed due to their atypical symptoms.

Research objectives

This study aimed to investigate the clinical characteristics of patients with CAP-induced RM to avoid missed diagnosis or misdiagnosis.

Research methods

In this retrospective study, baseline information, test results, and prognosis of 11 patients with CAP-induced RM were summarized and compared with those of 48 patients with exercise-induced RM. Statistical analysis was performed using SPSS 17.0 statistical software.

Research results

CAP-induced RM was more common in men. The major clinical manifestations were high fever and respiratory symptoms, but lacked symptoms typical of RM. Most patients had elevated inflammatory parameters, respiratory alkalosis, and 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 substantially 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.

Research conclusions

CAP can induce RM, which is rare and different from RM induced by exercise. Early detection and treatment could avoid missed diagnosis or misdiagnosis and reduce complications.

Research perspectives

We should pay special attention to the possibility of RM in CAP patients presenting with muscle pain, weakness, dark urine, or reduced urine output, particularly in male patients presenting with fever. For patients with abnormalities in hepatic and renal function and cardiac enzymes, with or without metabolic acidosis and hyperkalemia, creatine kinase and myoglobin should be tested and actively monitored. Early detection and treatment could reduce renal function deterioration and other complications, as well as shorten the treatment course.