Severe Rhabdomyolysis as an Unusual Presentation of Primary Human Immunodeficiency Virus Infection

Abstract

Rhabdomyolysis is characterized by muscle necrosis and leakage of toxic intracellular contents into the circulatory system. It is most commonly caused by trauma, physical exertion, drugs, toxins, and a variety of infections; only rarely is it associated with acute human immunodeficiency virus (HIV) infection alone. The severity of illness ranges from asymptomatic elevations in serum muscle enzymes to life-threatening electrolyte imbalances and acute kidney injury. High HIV viral load is associated with higher muscle breakdown that increases the incidence of severe acute kidney injury and sometimes the need for renal replacement therapy. The introduction of highly active antiretroviral therapy (HAART) revolutionized the treatment of HIV infection and increased the life expectancy of such patients by suppressing viral replication. Myopathy is one of the neuromuscular manifestations of HIV. It can occur either as a result of a complication of HIV itself or as a result of medicines used to control HIV. Muscle involvement of HIV infection ranges from asymptomatic muscle enzyme elevation to severe, HIV-associated polymyositis or pyomyositis. Here we report a case of acute retroviral syndrome presenting as severe non-traumatic rhabdomyolysis.

Human Immunodeficiency Virus (HIV) Masquerading as Myopathy and Rhabdomyolysis

“…A retrospective study demonstrated that lower viral loads were more consistent with anti-retroviralinduced myopathy. In our patient, HIV myopathy likely resulted from direct viral replication within the muscle leading to rhabdomyolysis and widespread fatigue [5]. Moreover, severe HIV presentation incited immunosuppression may predispose to acute myositis, as observed from our patient's AIDS defined CD4 count of 195 cell/UL [6].…”

Acute HIV presenting as rhabdomyolysis

“…Immune-mediated mechanisms activated by HIV itself were proposed as a mechanism for skeletal muscle involvement in HIV. Inflammatory cell infiltration into the muscle leads to muscle cell injury and breakdown 7…”

Acute HIV Induced Rhabdomyolysis: Not on Antiretroviral Therapy

“…Due to the severe morbidity and mortality associated with rhabdomyolysis (severe electrolyte imbalance, and acute renal failure) in the HIV population, prompt recognition is important to expedite and initiate treatment [10]. Increasingly recognized, rhabdomyolysis in an otherwise healthy individual with high risk sexual behaviors may warrant further investigation of acute HIV infection as the cause of their rhabdomyolysis.…”