Myocarditis and diaphragmatic rhabdomyolysis with respiratory failure in a patient with metastatic melanoma treated with Nivolumab

Introduction Immunotherapy dramatically changed history of melanoma patients with a clinical benefit never seen before. Nevertheless, severe and unexpected adverse effects can occur, fortunately rarely. Case presentation We reported the case of a 75-year-old male patient affected by metastatic melanoma who developed myocarditis and acute rhabdomyolysis with secondary diaphragmatic dysfunction and consequent pulmonary restrictive syndrome after Nivolumab monotherapy. Blood tests and ultrasonography of the diaphragm revealing left hypokinesis suggested a Nivolumab-related rhabdomyolysis, as an immune-mediated adverse event. The rhabdomylolysis involved the diaphragm with consequent diaphragmatic weakness and respiratory distress. Mangement & outcome The patient had a slow but slight and progressive improvement of symptoms and vital signs post-treatment with high-dose corticosteroids. Discussion With this case report, we want to highlight the importance of rapid recognition and treatment of rare and unexpected, but potential serious immune-related adverse events. These events might happen despite the remarkable clinical benefits of immune checkpoint inhibitors. We do not know which patients will benefit from these therapies and why, when and in which cases adverse event will occur: we must not lower our attention.

Rhabdomyolysis Following Ad26.COV2.S COVID-19 Vaccination

We report the case of a 19-year-old male who complained of myalgia, muscle weakness, and darkened urine two days after receiving his Ad26.COV2.S (Johnson & Johnson, New Brunswick, New Jersey, United States) COVID-19 vaccination. Blood examination revealed an increased creatine kinase (CK) level, and his urinary dipstick tested positive for blood, indicative of acute rhabdomyolysis. Serum creatinine levels were normal. Rhabdomyolysis due to strenuous physical activity was ruled out and further diagnostics excluded an autoimmune cause. Under repeated treatment with intravenous fluid resuscitation (outpatient treatment), his symptoms resolved and peak CK levels of 44,180 U/L returned to almost normal levels within two weeks. Rhabdomyolysis is a rare, potentially fatal vaccine-induced reaction. Further research is needed to better understand the underlying pathomechanism and to investigate whether subcutaneous injection of vaccines may be able to prevent rhabdomyolysis.

TANGO-2 with Severe and Prolonged Rhabdomyolysis in a 2-year Old Male with Human metapneumovirus Infection. A case report and literature review.

We report a unique case of prolonged acute rhabdomyolysis in a 2-year-old male with known TANGO-2 mutation with delayed peak in creatinine kinase levels secondary to human metapneumovirus infection. Creatinine kinase peaked at 424,760 U/l on day 9 of hospitalization. Resolution of rhabdomyolysis was achieved using aggressive management with intravenous fluids with optimal urine output and no kidney injury. TANGO-2 patients may develop severe and prolonged rhabdomyolysis with a delayed peak suggesting the need for prolonged inpatient hospitalization to prevent life-threatening complications.

Clinical features of acute rhabdomyolysis in 55 pediatric patients

OBJECTIVE This study was designed to compare the clinical manifestations, laboratory tests, etiology, and prognosis of children with acute rhabdomyolysis (RM) at various ages. This study was designed to analyze the risk factors for acute kidney injury (AKI) in children with RM and to identify the role of neuromuscular and immunological disorders in children with RM. PATIENTS AND METHODS Clinical data for 55 children with RM were collected and statistically analyzed. Patients were stratified to an infant group (G1) (age <1 yr), preschool group (G2) (age 1-6 yr), school-age group (G3) (age 7-11 yr), and an adolescent group (G4) (age 12-16 yr). RESULTS The most common clinical features were dark urine (53%), myalgia (38%), and fever (24%). Patients in G1 had fever (71%), vomiting (78%), and abnormal urinalysis (14%), without triad clinical manifestations(myalgia, muscle weakness, and dark urine. 55% of patients in G4 group had myalgia; 71% had dark urine; 75% had abnormal urinalysis. The most common cause in each age group was as follows: sepsis (57%) in G1; hereditary neuromuscular diseases (44%) in G2; immunological disorders (40%) in G3; strenuous exercise (50%) in G4. Logistic regression analysis showed that AKI was not correlated with age, gender, or peak creatine phosphokinase. AKI was, however, associated with presence of an electrolyte disorder. CONCLUSION The clinical manifestations and laboratory findings in infants with acute RM are not typical and need to be taken seriously. The presence of an electrolyte disorder is a risk factor for AKI in children with RM. The most common pathogenesis of RM varies among age groups. Congenital hereditary disease and immunological disorders should not be ignored as a cause of RM in children.

Levetiracetam Treatment-Associated Acute Rhabdomyolysis in an Adolescent

Etiology of rhabdomyolysis includes hereditary muscle enzyme deficiencies, trauma, viral infections, excessive exercise, hypothyroidism, and medications such as colchicine, lithium, and statins. Several studies have reported that various antiepileptic drugs may induce rhabdomyolysis. Levetiracetam is one of the antiepileptic drugs implicated in the etiology of rhabdomyolysis. Herein, we present a case of rhabdomyolysis in an adolescent treated with levetiracetam. We wanted to draw attention to the increasing trend of levetiracetam-associated rhabdomyolysis frequency in pediatric patients.