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Archives of Medical Science
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vol. 14
Letter to the Editor

A pediatric case of rhabdomyolysis with acute renal failure due to co-infection with Epstein-Barr virus and Human herpesvirus 6

Marina Attanasi, Marianna Immacolata Petrosino, Paola Irma Guidone, Daniele Rapino, Laura Comegna, Nadia Rossi, Annalisa Blasetti, Francesco Chiarelli

Arch Med Sci 2018; 14, 1: 254–256
Online publish date: 2016/07/20
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Rhabdomyolysis is a syndrome characterized by muscle breakdown and necrosis resulting in leakage of the intracellular muscle constituents into the circulation and extracellular fluid. It ranges from an asymptomatic illness with elevation in creatine phosphokinase (CK) levels to a life-threatening condition characterized by electrolyte imbalances, acute kidney injury (AKI) and disseminated intravascular coagulation [1].
One of the most common etiologies of rhabdomyolysis in the pediatric population is viral [2, 3]. We report a rare childhood case of rhabdomyolysis associated with a dual viral infection. Epstein-Barr virus (EBV) was identified serologically and Human herpesvirus 6 (HHV6) was individualized with quantification of DNA by real-time polymerase chain reaction (DNA PCR).
Informed consent of the patient’s parents was obtained.
A 22-month-old child was admitted to the Pediatrics Department (University of Chieti) for incoercible vomiting (about 10 episodes in the past 12 hours) and inappetence. She had a history of malaise, sore throat and irritability for about 2 days. There was no family history of renal, musculoskeletal or metabolic diseases. She did not take drugs in the previous 2 weeks before the admission. The child’s mother reported a head injury by falling out of bed 24 h before. For this reason an urgent brain computed tomography scan was performed, showing no abnormalities. Physical examination was normal: blood pressure 108/67 mm Hg, pulse rate 115 beats/min and temperature 36°C. Chest and cardiac auscultation were normal, while the abdomen was widely painful. There were no evident signs of myopathy. Some small axillary and inguinal lymph nodes were palpated. Liver and spleen were not enlarged. Blood work revealed lactate dehydrogenase 2988 U/l (N: 313–618 U/l), creatine phosphokinase 2443 U/l (N: 30–135 U/l), aspartate aminotransferase 898 U/l (N: 14–36 U/l), alanine aminotransferase 2135 U/l (N: 19–52 U/l) and myoglobin 1510.0 ng/ml (N: 9.0–82.5 U/l), consistent with skeletal muscle necrosis. No measurement of myoglobin in urine was performed. WBC count was 10.25 × 103/µl (N: 4–10 × 103/µl) with 51% neutrophils, 39.5% lymphocytes and 8.3% monocytes. Following the admission the child had impaired renal function: serum creatinine level was 2.60 mg/dl (N: 0.52–1.04), urea 87 mg/dl (N: 7–17), sodium 131 mmol/l (N: 133–145), potassium 5.6 mmol/l (N: 3.60–5.50), calcium 2.30 mmol/l (N:...

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