A Rare Pediatric Case of Severe Rhabdomyolysis Owing to Dual Infection

Özben Akıncı Göktaş; Ömer Bektaş; Gökçen Öz Tunçer; Zeynep Birsin Özçakar; Beril Talim; Fatma Tuba Eminoğlu; Serap Teber

doi:10.1055/a-1486-7186

Klinische Pädiatrie, Table of Contents

Klin Padiatr 2022; 234(02): 119-122
DOI: 10.1055/a-1486-7186

Short Communication

A Rare Pediatric Case of Severe Rhabdomyolysis Owing to Dual Infection

Seltener Fall schwerer koinfektionsbedingter Rhabdomyolyse im Kindesalter

Özben Akıncı Göktaş

¹Department of child neurology, Ankara University Faculty of Medicine, Ankara, Turkey

,

Ömer Bektaş

¹Department of child neurology, Ankara University Faculty of Medicine, Ankara, Turkey

,

Gökçen Öz Tunçer

¹Department of child neurology, Ankara University Faculty of Medicine, Ankara, Turkey

,

Zeynep Birsin Özçakar

²Department of child nephrology, Ankara University Faculty of Medicine, Ankara, Turkey

,

Beril Talim

³Department of pediatric pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey

,

Fatma Tuba Eminoğlu

⁴Department of Pediatric Metabolic Disseases, Ankara University Faculty of Medicine, Ankara, Turkey

,

Serap Teber

¹Department of child neurology, Ankara University Faculty of Medicine, Ankara, Turkey

› Author Affiliations

Abstract

Aim We aimed to report a severe and rare pediatric rhabdomyolysis case associated with a dual viral infection.

Case A 13 year-old, healthy girl presented with the complaints of fever, abdominal pain, weakness and dark-colored urine. She was diagnosed with rhabdomyolysis based on clinical signs and laboratory findings. The diagnosis was confirmed by serological tests and real-time polymerase chain reaction for Epstein-Barr virus (EBV) and cytomegalovirus (CMV), respectively. Other potential genetic, metabolic and infectious causes were evaluated meticulously but no evidence was found. This case is also important as it is the first reported case to our knowledge on rhabdomyolysis associated with EBV and CMV co-infection in children.

Conclusion The presented case experienced tetraplegia due to the severe muscular damage and muscle power returned to normal range after 3 months. This suggests that EBV and CMV may have exert synergistic effects leading to more severe inflammation and degeneration.

Zusammenfassung

Ziel Unser Ziel war es, einen schweren und seltenen Fall von Rhabdomyolyse im Kindesalter zu berichten, der im Zusammenhang mit einer Koinfektion mit zwei Viren auftrat.

Fall Ein 13-jähiges gesundes Mädchen kam mit Fieber, Bauchschmerzen, Schwäche und dunklem Urin zur Aufnahme. Anhand der klinischen Symptomatik und Laborergebnisse wurde die Diagnose Rhabdomyolyse gestellt. Mittels serologischer Tests und Real-Time-Polymerase-Kettenreaktion erfolgte der Nachweis von EpsteinBarr-Virus (EBV) und Zytomegalievirus (CMV) und die Bestätigung der Diagnose. Andere mögliche genetische, metabolische und infektiöse Ursachen wurden genauestens untersucht, ließen sich jedoch nicht nachweisen. Der Fall ist auch deshalb wertvoll, weil es sich um den ersten Fall von Rhabdomyolyse im Rahmen einer EBV- und CMV-Koinfektion in Kindsalter handelt.

Schlussfolgerung Im vorgestellten Fall kam es durch die schwere Muskelschädigung zu einer Tetraplegie. Bis zur Normalisierung der Muskelkraft vergingen drei Monate. Dies weist darauf hin, dass das EBV und CMV einen synergistischen Effekt ausgeübt haben könnten, der dann zu schwereren entzündlichen und degenerativen Reaktionen führte.

Key words

Rhabdomyolysis - Childhood - Epstein-Barr virus (EBV) - Cytomegalovirus (CMV) - Dual Infection

Schlüsselwörter

Rhabdomyolyse - Kindesalter - Epstein-Barr-Virus (EBV) - Zytomegalievirus (CMV) - Koinfektion

Full Text

References

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