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Review
. 2022 Mar 21;27(1):45.
doi: 10.1186/s40001-022-00675-2.

Acute rhabdomyolysis in hepatitis-associated aplastic anemia patient undergoing allogeneic hematopoietic stem-cell transplantation: case report and literature review

Yuzhu Li #  1 , Yilei Hong #  1 , Yingying Shen  1   2 , Qi Liu  1 , Ying Chen  1   2 , Keding Shao  2   3 , Yiping Shen  1   2 , Baodong Ye  4   5 , Dijiong Wu  6   7
Affiliations
Review

Acute rhabdomyolysis in hepatitis-associated aplastic anemia patient undergoing allogeneic hematopoietic stem-cell transplantation: case report and literature review

Yuzhu Li et al. Eur J Med Res. .

Abstract

Background: Hepatitis-associated aplastic anemia (HAAA) is a specific type of aplastic anemia, and hematopoietic stem-cell transplantation (HSCT) is recommended as the first-line. Acute rhabdomyolysis (AR) during hematopoietic stem-cell transplantation (HSCT) is a rare, serious complication, with only 10 cases reported in the world so far.

Case presentation: Herein, we present a case of AR developing during HLA-haploidentical HSCT in a 55-year-old man who suffered from HAAA. On day 7 after stem cell transfusion, the patient reported a muscle pull in thigh and complained of muscle swelling, pain and change in urine color. Despite the timely diagnosis (based on the levels of myoglobin and creatine kinase, and muscle MRI findings, etc.) and rapid hydration and alkalization, the situation progressed dramatically, and the patient died of multi-organ failure during the preparation for continuous renal replacement therapy (CRRT). Five days after his death, the whole-exome sequencing result confirmed that the patient had a germline missense mutation in SCN4A I 1545 V and ACTN3 R577X.

Conclusion: AR is a rare but threatening complication during HSCT, especially in cases with kidney dysfunction. The creatine kinase level may not truly and completely reflect the severity and prognosis for cases with localized lesion. We suggest that genetic analysis should be performed for better understanding the pathological changes of AR during HSCT, especially for patients with bone marrow failure.

Keywords: Anemia, aplastic; Hematopoietic stem cell transplantation; Hepatitis; Rhabdomyolysis.

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Conflict of interest statement

The authors declare no competing interest.

Figures

Fig. 1
Fig. 1
Changes in urine color. 1A: Shown in brown; 1B: shown in cola
Fig. 2
Fig. 2
Swelling of the left thigh. The circumference 10 cm above patella was 41 cm on the left compared to that was 35.5 cm on the right; and the circumference 10 cm below patella was 32.5 cm on the left compared to that was 29.5 cm on the right
Fig. 3
Fig. 3
Magnetic resonance imaging (MRI) changes of the left thigh. The posterior and anteromedial muscles of the left thigh (gluteus maximus, rectus femoris, adductor longus, adductor brevis, and adductor magnus) and subcutaneous showed with fat exudative changes, and the interstitial space became blurred
See this image and copyright information in PMC

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