[Difficult course of rhabdomyolysis in influenza A/H1N1]

Abstract

History and admission findings: A 37-year-old man complained about a lack of strength, an unproductive cough and myalgia predominantly thigh-focused with subfebrile temperatures for days.

Investigations: Laboratory investigations indicated rhabdomyolysis with acute kidney injury (AKI). Drug misuse was denied. Exertion and trauma could be excluded as well as rheumatologic or other infectious causes often responsible for rhabdomyolysis. PCR of a nasopharyngeal swab was positive for influenza A virus subtype H1N1.

Treatment and course: Because of a progressive course of AKI haemodialysis was initiated. Levels of creatine kinase declined and urinary excretion rised. Hypocalcaemia due to secondary hyperparathyreoidism was substituted. During hospitalisation two seizures appeared. After performing a magnetic resonance imaging (MRI) the seizures could be attributed to a posterior reversible encephalopathy syndrome (PRES) secondary to influenza infection. A medication with valproic acid was initiated.

Conclusion: Extrapulmonary manifestations of an influenza A (H1N1) virus infection are rare but have to be considered after exclusion of differential diagnosis in younger patients in particular. In addition to a therapy with neuraminidase inhibitors a symptomatic treatment is of paramount significance.