Rhabdomyolysis and concomitant neurological lesions after intravenous heroin abuse.

Gans, Jeremy; Stam, Jeantine; Wijngaarden, G.K. van

doi:10.1136/jnnp.48.10.1057

Cited by 48 publications

(19 citation statements)

References 11 publications

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“…Die wenigen in der Literatur beschriebenen Fälle sind klinische Darstellungen oder Obduktionsfälle [1,2,3,4,7,8,9].Als Erklärung für die Rhabdomyolyse wird am häufigsten die lokale Gewebekompression bei entsprechender Lagerung angeführt, auch hyperergische Wirkungen von Heroin werden diskutiert [3,7,8]. Im vorliegenden Fall spricht die annähernd symmetrische Verteilung der Läsionen an nicht druckexponierten Muskelgruppen gegen eine rein mechanische Ursache.…”

Section: Diskussionunclassified

“…Eine Vaskulitis wie bei hyperergischer Reaktion konnte nicht verifiziert werden. Eine direkte toxische Wirkung von Opioiden als primäre Auslöser einer Rhabdomyolyse ist beschrieben [2,3,6]. Möglicherweise wird diese toxische Wirkung durch eine Kombination mit der verminderten Sauerstoffzufuhr bei zentraler Atem-und Kreislaufdepression verstärkt [5].…”

Section: Diskussionunclassified

“…Möglicherweise wird diese toxische Wirkung durch eine Kombination mit der verminderten Sauerstoffzufuhr bei zentraler Atem-und Kreislaufdepression verstärkt [5]. Es sind mehrere Fälle beschrieben mit ähnlich hohen Myoglobin-und Kreatininkinasewerten wie im vorgestellten Fall, bei denen es im Verlauf zu einer Restitutio ad integrum kam [2,9]. In einigen Fällen konnten auch pathologisch-anatomisch Regenerate der Skelettmuskulatur festgestellt werden [1,8].…”

Section: Diskussionunclassified

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Ausgedehnte bilaterale Unterschenkelmuskelnekrosen nach nasaler Heroinapplikation

Oehler¹,

Sinicina²,

Helpap³

2002

Der Pathologe

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Rhabdomyolysis is one of the less known complications of heroin abuse. A case of lower leg muscle necrosis after nasal application of heroin is reported with repeated resection of the necrotic muscles. Superinfection with a methicillin-resistant Staphylococcus aureus (MRSA) strain was present. After 4 weeks, bilateral amputation could not be avoided. We regard a direct toxic effect of the heroin as the most probable mechanism of the muscular damage, with possible influence of the reduced oxygen delivery due to central respiratory and circulatory depression.

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Section: Diskussionunclassified

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Ausgedehnte bilaterale Unterschenkelmuskelnekrosen nach nasaler Heroinapplikation

Oehler¹,

Sinicina²,

Helpap³

2002

Der Pathologe

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“…Other non-neuroleptic drugs causing NMS include amoxipine [7], phenytoin intoxication [8], sulpiride [9], trimipramine [10], tiapride [11], lithium [12], biperidin [13], clozapine plus lithium [14], phenelzine plus lithium [15], and clozapine and carbamazepine [16]. Heroin is known to cause rhabdomyolysis but not NMS [24]. It has been suggested that death in cocaine overdose or abuse may be secondary to the NMS [17].…”

Section: Discussionmentioning

confidence: 99%

Four Cases of Neuroleptic Malignant Syndrome

et al. 1992

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The neuroleptic malignant syndrome (NMS) is a relatively uncommon, sometimes fatal, idiosyncratic drug reaction usually associated with the administration of neuroleptic drugs. The syndrome is characterized by generalized rigidity, fever, altered consciousness or mutism, tremor, autonomic dysfunction, tachypnea, elevated serum creatinine phosphokinase, leukocytosis and myoglobinuria. We report four cases of NMS; one following levodopa/bromocriptine withdrawal, two related to neuroleptic administration and one following heroin use. There are no previous reports linking heroin to NMS. The syndrome is thought to result from acute dopaminergic blockage or dopamine depletion. Levodopa, bromocriptine or both are recommended as specific treatment for this condition. Most cases of NMS occur following the administration of neuroleptic drugs. Recently, the syndrome has been described in patients on nonneuroleptic drugs [7][8][9][10][11][12][13][14][15][16][17] and after the withdrawal of certain drugs, especially antiParkinson medication [18,19]. This paper describes four cases of NMS recently encountered; one following levodopa/bromocriptine withdrawal, one probably due to heroin "snorting" and two related to neuroleptic administration. While heroin is known to produce rhabdomyolysis, there are no previous reports of its producing NMS. Case 1A 14-year-old Saudi female was brought to the hospital unresponsive. Forty days prior to admission trifluoperazine and imipramine were prescribed for agitation, anxiety, confusion and paranoia. She did not respond and eight days prior to admission these drugs were replaced by haloperidol 3 mg b.i.d. She developed progressive sluggishness, falling down spells, opisthotonic events, urinary incontinence and finally became unresponsive.On examination, her blood pressure was 104/60 mm Hg, pulse rate 150/min, respirations 40-60/ min and temperature was 38.9°C. There were bruises and abrasions on her shins. She respondedminimally to pain. Pupils were mid-position and reacted sluggishly. The limbs moved symmetrically· There was generalized rigidity including neck muscles and a fine tremor of the hands. Tendon reflexes were symmetrical and the plantar responses normal. Pertinent laboratory data: white blood count (WBC) was 16,000/mm 3 . Urinalysis was strongly positive for blood using the dip stick, but microscopic examination showed 0-1 red blood cells (RBC) per high powered field (HPF) strongly suggesting myoglobinuria. Serum lactic dehydrogenase (LDH) was 4,599 U/L, serum glutamic oxaloacetic transaminase (SGOT) 1381 U/L, serum glutamic pyruvic transaminase (SGPT) 236 U/L, total bilirubin 25 μmοl/L and direct bilirubin 6 μιηοΙ/L. Lumbar puncture opening pressure was 230 mm of water. Cerebrospinal

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“…20,[23][24][25][26][27][28] Our patient admitted to a period of abstinence of 6 months from heroin injection when she presented to the hospital. Hypothyroid patients can have myopathy with mild elevation of CK levels but there are few case reports in the literature where hypothyroidism presented with rhabdomyolysis and even acute renal failure.…”

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confidence: 99%

Bilateral Atraumatic Compartment Syndrome of the Legs Leading to Rhabdomyolysis and Acute Renal Failure Following Prolonged Kneeling in a Heroin Addict. A Case Report and Review of Relevant Literature

Biswas¹,

Rao²,

Duckworth³

et al. 2013

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Introduction Compartment syndrome is defined as a symptom complex caused by increased pressure of tissue fluid in a closed osseofascial compartment which interferes with circulation to the myoneural components of the compartment. Bilateral compartment syndrome of the legs is a rare presentation requiring emergent surgical intervention. In a recent case report (Khan et al 2012) there have been only eight reported cases cited with bilateral compartment syndrome. Heroin abuse is known to cause compartment syndrome, traumatic and atraumatic rhabdomyolysis. Hypothyroidism can also independently present with rhabdomyolysis. Case presentation We present a case of a 22 years old female who presented with bilateral swelling of the legs with associated loss of sensation having spent two days kneeling against the wall following IV heroin abuse. She presented to the emergency department with bilateral swelling of the legs with loss of sensation. She was diagnosed with compartment syndrome requiring emergent bilateral 4 compartment fasciotomy of the lower extremities. Inspite of aggressive fluid resuscitation she developed rhabdomyolysis complicated by acute renal failure requiring dialysis. She made a full recovery with full return of her renal as well as motor and sensory function. Conclusion We discuss this interesting case of bilateral compartment syndrome in a heroin abusive patient with history of hypothyroidism complicated by rhabdomyolysis and acute renal failure. There have been isolated case reports of bilateral compartment syndrome following prolonged surgery. High index of suspicion, early recognition and therapeutic intervention is the key to good outcome. We discuss the etiopathology and management options of rhabdomyolysis. Treating the comorbities like hypothyroidism is also important for the recovery. How to cite this article Biswas S, Rao RS, Duckworth A, Kothuru R, Flores L, Abrol S. Bilateral Atraumatic Compartment Syndrome of the Legs Leading to Rhabdomyolysis and Acute Renal Failure Following Prolonged Kneeling in a Heroin Addict. A Case Report and Review of Relevant Literature. J Trauma Critical Care Emerg Surg 2013;2(3):139-145.

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Rhabdomyolysis and concomitant neurological lesions after intravenous heroin abuse.

Cited by 48 publications

References 11 publications

Ausgedehnte bilaterale Unterschenkelmuskelnekrosen nach nasaler Heroinapplikation

Ausgedehnte bilaterale Unterschenkelmuskelnekrosen nach nasaler Heroinapplikation

Four Cases of Neuroleptic Malignant Syndrome

Bilateral Atraumatic Compartment Syndrome of the Legs Leading to Rhabdomyolysis and Acute Renal Failure Following Prolonged Kneeling in a Heroin Addict. A Case Report and Review of Relevant Literature

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