Severe falciparum malaria with dengue coinfection complicated by rhabdomyolysis and acute kidney injury: an unusual case with myoglobinemia, myoglobinuria but normal serum creatine kinase

BMC Infectious Diseases

Chian Yong Low¹  Ban Hock Tan¹  Kok Pin Yong¹ 

[1] Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore

关键词: Acute kidney injury;    Myoglobinuria;    Rhabdomyolysis;    Falciparum malaria;   

Others  :  1158672
DOI  :  10.1186/1471-2334-12-364

 received in 2012-04-12, accepted in 2012-12-19,  发布年份 2012

【 摘 要 】

Background

Acute kidney injury (AKI) is a complication of severe malaria, and rhabdomyolysis with myoglobinuria is an uncommon cause. We report an unusual case of severe falciparum malaria with dengue coinfection complicated by AKI due to myoglobinemia and myoglobinuria while maintaining a normal creatine kinase (CK).

Case presentation

A 49-year old Indonesian man presented with fever, chills, and rigors with generalized myalgia and was diagnosed with falciparum malaria based on a positive blood smear. This was complicated by rhabdomyolysis with raised serum and urine myoglobin but normal CK. Despite rapid clearance of the parasitemia with intravenous artesunate and aggressive hydration maintaining good urine output, his myoglobinuria and acidosis worsened, progressing to uremia requiring renal replacement therapy. High-flux hemodiafiltration effectively cleared his serum and urine myoglobin with recovery of renal function. Further evaluation revealed evidence of dengue coinfection and past infection with murine typhus.

Conclusion

In patients with severe falciparum malaria, the absence of raised CK alone does not exclude a diagnosis of rhabdomyolysis. Raised serum and urine myoglobin levels could lead to AKI and should be monitored. In the event of myoglobin-induced AKI requiring dialysis, clinicians may consider using high-flux hemodiafiltration instead of conventional hemodialysis for more effective myoglobin removal. In Southeast Asia, potential endemic coinfections that can also cause or worsen rhabdomyolysis, such as dengue, rickettsiosis and leptospirosis, should be considered.

【 授权许可】

   
2012 Yong et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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