A Case of Rhabdomyolysis Leading to ESRD Secondary to Influenza A Infection in a 70-Year-Old Patient

Introduction: Rhabdomyolysis is a serious clinical syndrome characterized by muscle breakdown and release of damaging proteins. Influenza infection has been increasingly reported as a causative disease. We are reporting an unusual case of severe rhabdomyolysis with acute renal failure leading to ESRD due to influenza A infection Case Description: A 70-year-old female with PMHx of hyperlipidemia and hypothyroidism, admitted with body aches along with flulike symptoms for 4 days duration, no history of seizure or trauma, only on levothyroxine at home. Physical exam with stable vital signs, clear lungs. Labs were pertinent for WBC 31.0x109, eosinophilia 20%, creatinine 1.4mg/dl (baseline 0.9) and AST/ALT 2590/530 mg/dl, hepatitis screen negative, urine analysis with +3 blood, 3 RBCs, +1 protein. CK 104,740 U/L, influenza A PCR positive, negative PCR for influenza B, COVID 19. Diagnosis of acute renal failure secondary to rhabdomyolysis secondary to influenza A was made, patient was started on oseltamivir and required renal replacement therapy, no recovery after 3 months and labeled ESRD Discussion: Influenza A is a negative-sense RNA virus, transmitted by large droplets and small particle aerosols, complication of influenza includes but not limited to pneumonia, encephalitis, myocarditis and Myositis which can be secondary to Direct invasion of muscle tissue by the viral agent, Myotoxic cytokines release and Immunologic processes induced by the viral infection. Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. It might occur due to trauma, drugs, bacterial or viral infections or others, Creatine kinase levels are typically elevated. The risk of AKI is higher with CK levels of more than 15 to 20,000 units/L, caused mainly by Volume depletion resulting in renal ischemia, tubular obstruction due to heme pigment casts, and tubular injury from free chelatable iron. Treatment is mainly by large volume administration of isotonic fluids, renal replacement therapy may be needed for sever cases. Conclusion(s): Influenza can be a serious disease leading to serious complications, extra caution should be considered in patients who develop acute renal failure after influenza infection;rhabdomyolysis should be suspected, investigated, and treated appropriately.

Sickle Cell Disease (SCD) As a Risk for COVI19 Compared to Those without SCD Among Patients Admitted in a Large Urban Center, As Estimated By PCR Sars-v-2 Positive Vs Negative Testing

A diagnosis of SCD is considered to be at risk for COVD19. To further define the association between SCD and infection with COVID-19, we estimated risk, by comparing presence or absence of COVID19 infections in individuals with and without SCD admitted concurrently to a large urban health care facility (Grady Memorial Hospital, Atlanta, GA;960 beds, 5th largest public hospital in the US). Primary outcome was a positive or negative COVID-19 diagnosis as defined bySARS-CoV-2 PCR testing. A patient was considered to be COVID-19 positive if tested positive withSARS-CoV-2 PCR for the first time, anytime during the study period, irrespective of number of tests. A patient was considered to be COVID-19 negative if patient had no positive tests during the study period, and had one or moreSARS-CoV-2 PCR negative tests. For COVID19 positive patients, the admission of theSARS-CoV-2 PCR positive test was included in the analysis. For COVID19 negative patients, the first admission with aSARS-CoV-2 PCR negative test was considered for analysis. For this interim analysis, SCD was defined by ICD10 and registry data. Clinical diagnosis such as obesity and respiratory failure were defined by ICD10 coding. Data was obtained from quarterly centralized Epic EMR data extractions. Analysis of outcome of COVID19 positive vs negatives was stratified in four separate analysis: all admissions, ICU admissions, those with respiratory failure and those who died. Multivariate dichotomous logistic regression analyses modeled binary outcome effect of SCD, adjusted for age (<40 vs. > 40 years), sex at birth (females vs. males) and obesity (SAS version 9.4 was used for statistical analyses and overall significance level was set at 0.05). To ensure population homogeneity analysis was conducted on patient ages 20 to 60 years that were Black/African American and admitted from the Emergency Department for a short stay and/or the medicine service (variable interactions at a p<0.01). The study was approved by the institutional review board and by the hospital research oversight committee. Overall, between 3/23/2020 and 6/30/2020, 23697 patients were admitted once or more to Grady Memorial Hospital with one or more PCR sars-cov-2 test, of these 405 were patients with SCD (1.7%). Of the total, 2566 patients (10.8%) tested positive for COVID-19, and 48 patients with SCD (11.8%) were positive. Of 7041 (29.7%) were part of the study population, 332 (4.7%) where patients with SCD (hemoglobin [hb] SS/Sbeta0 =252, hbSC n=55, hbS beta thalassemia+ or hbS beta thalassemia undetermined n=21). Among patients without SCD, 36.3% were female, (n=2557) and among patients with SCD, 53.6% (n=178). The mean age of patients without SCD was: 51.1 years (standard deviation [std]) +/- 19.5 years), and for those with SCD: 35.0 years (std +/- 12.0 years). Results of univariate and multivariate analysis are presented in the table. In conclusion, in a Black/African American patients admitted from the Emergency Room for observation and/or the internal medicine service, when adjusted for age, gender and obesity, with SCD are at a significant increased risk for admissions with COVID-19 infection in general as well as ICU admission or admission with respiratory failures. Further studies can help articulate the risk associated with SCD as well as its potential interaction with other factors, with attention to confounders. [Formula presented] Disclosures: No relevant conflicts of interest to declare.