횡문근융해증과 급성 신손상이 합병된 살모넬라 감염 1례

Abstract

Rhabdomyolysis a clinical syndrome characterized by injury to skeletal muscle and release of intracellular contents into the systemic circulation, can develop from infections, although trauma is a more common cause. Myoglobinuric acute kidney injury (AKI) is a potentially life-threatening complication of rhabdomyolysis. Reports of rhabdomyolysis and AKI induced by almonella infection are rare in the Korean literature. This paper describes a case of salmonella enteritis complicated by rhabdomyolysis and AKI. A 58-year-old man presented to the hospital with a two day history of watery diarrhea, abdominal pain and high fever. Initial blood chemistry revealed a serum creatinine (Cr) level of 3.4 mg/dL, with elevations of serum creatine phosphokinase (CK, 5,635 IU/L) and serum myoglobin (>3,000 ng/mL). Intravenous hydration and empirical antibiotic treatment with ciprofloxacin were initiated. Blood and stool cultures grew salmonella group B, which was sensitive to ciprofloxacin, ampicillin, and ceftazidime. Parenteral ciprofloxacin was continued for 14 days. During the first week of hospitalization, peak levels of serum Cr and CK were 9.5 mg/dL and 89,155 IU/L, respectively. Thereafter clinical and biochemical parameters gradually improved without dialysis. The patient was discharged on the 20th hospital day with normal CK levels except for serum Cr. His renal function normalized (serum Cr 1.0 mg/dL) two months after discharge. Based on the results of this case, prompt fluid therapy and early administration of antibiotics should be performed in patients with salmonella infection complicated by rhabdomyolysis and AKI.