ABSTRACT
Acute kidney injury (AKI) is a severe complication of rhabdomyolysis, a clinical syndrome characterized by the damage of skeletal muscle and the subsequent release of its breakdown products into the bloodstream. Case Presentation: A 32-year-old previously healthy male who had generalized body pain, dark-colored urine, nausea, and vomiting for 2 days, presented to the hospital after he performed a vigorous gym workout. Blood results revealed creatine kinase of 39 483 U/l (normal range: 1-171 U/l), myoglobin 224.9 ng/ml (normal range: 0-80 ng/ml), serum creatinine 4.34 mg/dl (normal range: 0.6-1.35 mg/dl), and serum urea 62 mg/dl (normal range: 10-45 mg/dl). Based on clinical and laboratory findings, he was diagnosed with exercise-induced rhabdomyolysis with AKI; he was successfully treated with isotonic fluid therapy and titrated accordingly without requiring renal replacement therapy. After 2 weeks of follow-up, a full recovery was seen. Clinical Discussion: Between 10 and 30% of people with exercise-induced rhabdomyolysis are thought to develop AKI. Exercise-induced rhabdomyolysis is typically characterized by symptoms such as muscle discomfort, weakness, fatigue, and black urine. An initial diagnosis is often made when creatine kinase levels are more than five times the upper limit, and there has been a recent history of intense physical activity. Conclusion: This case highlighted the potentially life-threatening risks associated with unexpected physical activity and underlined the critical preventative steps to lower the likelihood of experiencing exercise-induced rhabdomyolysis.
ABSTRACT
Introduction and importance: Pericarditis is a common illness that can appear in a variety of clinical settings and has numerous causes. In developing nations where tuberculosis is still a serious public health issue, more than 50% of cases of pericarditis are related to tuberculosis. Case presentation: There was no history of TB, alcoholism, IV drug abuse, immunosuppressant, or corticosteroid use. On examination, she had a fever, tachycardia, pulsus paradoxus of 10 mmHg, hypotension, tachypnea, and a distended jugular vein. On auscultation, her heartbeats were muffled, and accompanied by a pericardial rub. Laboratory investigation showed low hematocrit and a high WBC count with lymphocyte predominance. ESR and CRP levels were elevated. Her chest X-ray revealed an enlargement of the cardiac silhouette. The ECG showed low voltage complexes. Echocardiography showed circumferential 30 mm × 25 mm pericardial effusion with fibrin strands in the visceral pericardium. An emergency pericardiocentesis was performed under the guidance of transthoracic echocardiography using sub-xiphoidal standards. Microbiologic analysis of the pericardial fluid confirmed tuberculosis. After successful pericardiocenthesis, the patient's condition improved massively. After three days of pericardiocentasis drainage, TB treatment was started and she was discharged for outpatient flow up. Clinical discussion: Tuberculous pericarditis is a serious tuberculosis (TB) complication that can be difficult to diagnose and often goes undetected, leading to late complications such as constrictive pericarditis and cardiac tamponade, which lead to increased mortality. This current case illustrates a young female patient presenting with isolated TB pericarditis complicated by cardiac tamponade. She had massive improvement following pericardiocentesis and anti-TB treatment. Conclusion: In Africa, tuberculous pericarditis should be considered as a differential diagnosis in any patient presenting with moderate to massive pericardial effusion. A high index of suspicion is required for the diagnosis of extrapulmonary TB pericarditis, especially in patients without known risk factors.
