Rhabdomyolysis Associated With 2009 Influenza A(H1N1)
Rhabdomyolysis Associated With 2009 Influenza A(H1N1) Vol. 302 No. 17, November 4, 2009
28 y/o female, BMI 40
1. Lab:
- white blood cell count, 2800/µL
- lactic dehydrogenase, 1875 U/L (normal, 112-220 U/L)
- creatine kinase level, 27 820 U/L (normal, 13-156 U/L)
- urinalysis revealed 3+ hemoglobin and 7 red blood cells per high-power field; myoglobin was not assayed.
2. 檢查：RT-PCR of nasopharyngeal smear was negative for influenza A. (BAL) fluid grew influenza A, identified as 2009 novel inflenza
3.治療：22 L/48 hr plus sodium bicarbonate.
4.Rhabdomyolysis 原因
- genetic defects
- trauma
- exertion
- muscle hypoxia
- body-temperature changes
- metabolic and electrolyte disorders
- drugs and toxins
- bacterial or viral infections
在目前發表的重症肺炎的案例裡，多數 62%有Creatinine kinase 的中度增高，rhabdomyolysis的可能性，不能予以輕易忽略排除！
在這個案例，值得注意的是假陰性的rt- PCR 不能除外下呼吸道的感染（肺炎），BAL 液體的檢查是必要的。
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