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

ABSTRACT

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.