Rhabdomyolysis Caused by Isotretinoin and Exercise in an Otherwise Healthy Female Patient

Abstract

Acne vulgaris is one of the most common skin conditions treated by healthcare providers. Isotretinoin is a well-known and effective treatment for nodulocystic and scarring acne. Rarely, and usually in combination with exercise, patients treated with isotretinoin can develop rhabdomyolysis, a potentially life-threatening breakdown of muscle associated with elevated creatine kinase (CK). Here, we report a rare case of a female patient developing rhabdomyolysis three months after starting exercise and isotretinoin. She was treated with supportive care and medication was discontinued, resulting in a full recovery. Careful inquiry into the patient's exercise habits, along with a thorough review of systems at each visit can help identify high-risk patients. Routine monitoring of liver enzymes, specifically aspartate aminotransferase elevations, may provide a prompt to check a patient’s CK. Though regular monitoring of CK is not currently recommended, given the prevalence of regular exercise in certain patient populations, this case reinforces the importance of counseling patients on this potential side effect.

Side Effects of Treating Acne Vulgaris With Isotretinoin: A Systematic Review

“…While receiving treatment, mild, non-specific musculoskeletal symptoms have been observed; however, they are not associated with radiographic abnormalities [ 15 ]. Exercise and the use of systemic isotretinoin may both work together to cause rhabdomyolysis [ 16 ]. Despite being a known potential side effect of isotretinoin use, routine screening or monitoring is not currently advised for rhabdomyolysis, the reason being its rarity [ 16 ].…”

“…Exercise and the use of systemic isotretinoin may both work together to cause rhabdomyolysis [ 16 ]. Despite being a known potential side effect of isotretinoin use, routine screening or monitoring is not currently advised for rhabdomyolysis, the reason being its rarity [ 16 ].…”