Rhabdomyolysis with different etiologies in childhood

Table 1 General characteristics of patients

Case no	Age (mo)	Gender	Presenting symptoms	Provacative factors	Positive physical examination findings	Past/family history	Attacs number
1	24	F	Dark colored urine, fever, cough	Infection	Fever, bilateral crepitationsin chest examination	Unremarkable	1
2	84	F	Fever, cough,myalgia, calf pain, fatigue, dark colored urine	Infection	Fever, bilateral crepitationsin chest examination	Unremarkable	1
3	192	M	Myalgia, calf pain, fatigue, dark colored urine, vomiting	Excess licorice use	Volume depletion signs, normal blood pressure	Unremarkable	1
4	132	F	Myalgia, calf pain, fatigue, muscle weakness, dark colored urine	Prolonged physical exercise	Muscle strengths 3-4/5 bilateral in upper and lower extremities	Recurrent rhabdomyolysis, parents are consanguineous	7
5	192	M	Myalgia, calf pain, fatigue, muscle weakness dark colored urine	Prolonged physical exercise	Muscle strengths 3-4/5 bilateral in upper and lower extremities	Recurrent rhabdomyolysis, parents are consanguineous	6
6	192	F	Myalgia, calf pain, fatigue dark colored urine	Infection, prolonged physical exercise	Muscle pain	Recurrent rhabdomyolysis, hemodialysis treatment 10 mo ago due to attack, parents are consanguineous	6
7	24	M	Dark colored urine, fever, cough	Infection	Fever, bilateral crepitationsin chest examination	Epilepsy, micocephalia	1
8	192	F	Myalgia, calf pain, fatigue dark colored urine	Prolonged physical exercise	Muscle pain	Recurrent rhabdomyolysis	3

M: Male; F: Female.

Table 2 Laboratory results of patients on admission

Case No.	Hb	WBC	Plt	Glu	BUN	Creat	CPK	AST	ALT	LDH	Uric acid	Na	K	Cl	Ca	P	Urine myog.	Blood myog.
	g/dL	/mm3	/mm3	mg/dL	mg/dL	mg/dL	U/L	IU/L	IU/L	U/L	mg/dL	mmol/L	mmol/L	mmol/L	mg/dL	mg/dL
1	8.6	17.5	225	86	36	2.3	1158	451	3903	1227	6.1	139	4.2	110	8.6	4.5	193	155
2	12.9	6.5	93	102	65	4.7	12976	788	215	933	6.8	149	4.8	114	7.8	8.3	679	274
3	15.2	20.6	307	95	150	3.7	8379	780	250	1100	10	125	2.2	65	8.2	8.8	1370	3740
4	12.6	3.6	163	90	57	7	42670	998	249	1303	2.6	136	3.9	107	8.7	4.3	1200	1200
5	13.2	10.6	213	75	12	0.5	3012	210	664	1466	3.5	141	4.9	104	9.9	4.3	1200	1200
6	12.4	17.5	127	119	10	0.7	25983	338	87	1797	5	136	3.9	105	9.4	3.5	1200	1200
7	9.3	9.6	146	85	38	1.1	31119	683	235	1853	6.9	144	2.9	115	8.4	3.7	767	800
8	14.2	18.6	332	90	12.5	0.8	51228	1108	341	2381	2.3	135	3.7	107	10.1	3.6	800	1200

Hb: Hemoglobin; WBC: White blood cell; Plt: Platelet; Glu: Glucose in urine; CPK: Creatine phospho kinase; BUN: Blood urea nitrogen; AST: Aspartate aminotransferase; LDH: Lactate dehydrogenase; ALT: Alanine aminotransferase.

Table 3 Management and final diagnosis of patients

Case	Management	Renal replacement therapy	Final diagnosis
1	Antibiotic treatment, hydration, alkalinization	No	Rhabdomyolysis associated with Mycoplasma pneumoniae pneumonia
2	Antibiotic treatment, hydration, alkalinization, fresh frozen plasma	No	Sepsis, pneumoniae, rhabdomyolysis
3	Hydration, alkalinization, antiemetic, hemodialysis	Yes, HD	Licorice-induced hypokalemic rhabdomyolysis
4	Hydration, alkalinization, hemodiyalysis	Yes, HD	Rhabdomyolysis with carnitine palmitoyltransferase II deficiency
5	Hydration, alkalinization	No	Rhabdomyolysis with carnitine palmitoyltransferase II deficiecy ?
6	Hydration, alkalinization	No	Rhabdomyolysis with very long-chain acyl-CoA dehydrogenase deficiency
7	Hydration,alkalinization	No	Rhabdomyolysis due to congenital muscular dystrophy
8	Hydration, alkalinization	No	İdiopathic paroxysmal rhabdomyolysis “Meyer- Betz Syndrome

HD: Hemodialysis.