Fatal sepsis complicating rhabdomyolysis on the extremities

Abstract

Sirs: We report a case of fatal sepsis complicating rhabdomyolysis on the extremities. A 67-year-old man was referred to our hospital complaining of upper abdominal pain, vomiting, and diarrhea for 1 week in October 1999. He had also suffered from severe muscle pain bilaterally in the anterior arms and distal legs beginning 1 day previously. He had suffered from chronic alcoholic pancreatitis, diabetes mellitus, and alcoholic liver cirrhosis for 5 years. Physical examination revealed a temperature of 39.3 C, blood pressure 176/ 64 mmHg, heart rate 84/min, and respiratory rate 50/min. Consciousness was clear, and no cyanosis was observed. He had slight tenderness in the upper abdominal lesion, and the extremities were extremely swollen with severe pain. Laboratory examination revealed normal blood cell counts except for a platelet count of 90,000/ mm 3 . Slight icterus and slight renal dysfunction were detected. Although serum creatine-phosphokinase level was high at 12500 IU/l, electrocardiography revealed no significant ST-T wave changes. Arterial blood gas examination suggested metabolic acidosis without hypoxia. Plain chest radiography revealed no abnormal findings, but plain abdominal radiography showed a large amount of gas in the small intestine. Acute exacerbation of chronic pancreatitis was initially suspected, but abdominal computed tomography revealed no findings of pancreatitis. Given the severe muscle pain and elevation in serum creatinephosphokinase level, rhabdomyolysis was suspected. Blood cultures were performed, and cefmetazole sodium was given intravenously. However, shock developed within a few hours. Although cardiopulmonary resuscitation was attempted, he died 5 h after admission. Vibrio vulnificus was detected in blood cultures, and death appeared to be due to V. vulnificus septic shock.Infection with V. vulnificus is one of the most severe of all food-borne infectious diseases and causes severe, fulminant sepsis principally in patients with chronic liver diseases [1]. V. vulnificus sepsis has also been reported in immunocompromised hosts such as hemodialyzed patients [2]. Mortality associated with sepsis from V. vulnificus infection is very high, over 50 % or even 90 % in the cases of patients with hypotension manifested within 12 h of the clinical examination [3]. Among patients with primary septicemia a history of raw oyster ingestion or seawater exposure is the prominent epidemiological feature [3]. In this case the patient often ate sushi, and may thus have eaten contaminated seafood. Up to 75 % of primary V. vulnificus septicemia cases develop secondary skin lesion, often noticed within 36 h of the onset of illness. Usually found on the extremities, these skin lesions are erythematous and tender. They may evolve to bullae formation, necrotic ulceration, or even gangrene with major vessel occlusion. Histopathology may show cellulitis with necrosis of subcutaneous fibroadipose tissue and transmural necrotizing vasculitis [4]. About 7 % of bacterial sepsis patients develop rhabdomyolysis,...

Rhabdomyolysis induced by Pseudomonas aeruginosa sepsis

“…In immunocompromised hosts or patients with chronic liver disease [10,11], Vibrio vulnifi cus can produce rhabdomyolysis by causing necrotising vasculitis [12]. In our patient, there was no evidence of immunodefi ciency or liver dysfunction.…”