A Case of Rhabdomyolysis Caused by Group A beta-hemolytic Streptococcal Tonsillopharyngitis / 대한신장학회잡지

Bywaters and beall first reported rhabdomyolysis during World War II; the pigmented casts were found in renal tubules of 4 patients who died of acute renal failure after crushing injury. Since then, several cases of rhabdomyolysis with or without acute renal failure have been reported. The causes such as surgical injuries, excessive exercise, and drug abuse have been suggested as possible etiologies of rhabdomyolysis. Rhabdomyolysis is a clinical syndrome as a result of releasing of myocyte components from the injured striated muscles into blood stream. Clinical manifestations have ranged from asymptomatic elevation of creatinine kinase to acute renal failure which is a life threatening medical emergency. The most common cause of rhabdomyolysis is traumatic muscular injury. The others include alcohol abuse, metabolic disorder, drug, toxins, carbon monoxide poisoning, burn, vascular occlusion, excessive exercise, and bacterial or viral infections and sepsis. Among these, rhabdomyolysis caused by Group A beta-hemolytic streptococcus is very rare. However, rhabdomyolysis due to pharyngitis has not been reported. We report a case of rhabdomyolysis associated with Group A beta-hemolytic streptococcus.

Clinical usefulness of Clinical Pulmonary Infection Score of ICU Patients with Sputum Culture positive for Multi-drug resistant Acinetobacter baumannii / 결핵

BACKGROUND: The hospital-acquired pneumonia is the most common nosocomial infection. Recently, the Acinetobacter baummannii infections are rapidly increasing, especially the frequency of Multi-drug resistant A. baumannii. Therefore we assessed clinical features and prognosis of patients in the ICU with Multi-drug resistant A. baumannii from the sputum culture using the Clinical Pulmonary Infection Score(CPIS). METHODS: The medical records of 43 patients with Multi-drug resistant A. baumannii from sputum culture who were suspected had clinically pneumonia and admitted to the ICU from January 2000 to July 2002 were retrospectively analyzed. RESULT: 19 patients were CPIS greater than 6 and 24 patients were CPIS less than or equal to 6. Mean age for the former was 71+/-11 years old, and the latter was 61+/-19 years old. The mean APACHE II score on admission and on sputum study was not different between two groups(17.4+/-5.7 vs 18.5+/-6.1, p=0.553, 20+/-6 vs 17+/-8, p=0.078). But the mortality rate was 73.7% for the former, and 16.7% for the latter(p<0.001). CONCLUSION: In ICU patients who had clinically suspected pneumonia with sputum culture positive for Multi-drug resistant A. baumannii, the mortality was significantly higher if CPIS was greater than 6.