Imatinib
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Rhabdomyolysis: case report A 46-year-old man developed rhabdomyolysis during treatment with imatinib for chronic myeloid leukaemia. The man presented to the emergency room with 5-day history of respiratory illness characterised by fever, cough, generalised muscle pain and dyspnoea. He had received last dose of imatinib 3 months prior to presentation with optimal improvement [dosage and route not stated]. He denied recent use of drugs, exposure to toxins or trauma. On admission, he had tachycardia, tachypnoea and hypoxemia. Physical examination showed bilateral pulmonary rales. A chest x-ray revealed bilateral diffuse ground-glass opacities with a predominantly peripheral distribution. Laboratory tests revealed severe metabolic acidosis, thrombocytopenia, lymphopenia, increased blood levels of creatinine, LDH, creatine kinase, AST, ALT, CRP, ferritin, fibrinogen and D-dimer, and electrolyte disturbances with hyperphosphataemia, hyperkalaemia and hypocalcaemia. Urinalysis revealed dark urine, urine dipstick positive for haemoglobin, and normal sediment compatible with myoglobinuria. His urinary volume in the first 12h of admission was 20mL. These findings were consistent with grade 3 acute kidney injury (AKI). Nasopharyngeal swab was positive for COVID-19 infection by real-time reverse-transcriptase-PCR (RT-PCR). Other viral aetiology was negative. Based on these clinical presentation, he was diagnosed with severe rhabdomyolysis associated with imatinib, which resulted in AKI. The man started receiving off label treatment with azithromycin and supplemental oxygen for COVID-19 infection. He also received unspecified IV solutions and sodium bicarbonate for metabolic acidosis in AKI, but without any response. He had persistent anuria and developed uraemic encephalopathy. Thereafter, he underwent continuous renal replacement therapy with continuous veno-venous haemodiafiltration modality. On admission day 5, he developed fever and increased procalcitonin. A repeat chest x-ray findings were suggestive of disease progression or bacterial superinfection. Therefore, he was started on unspecified broad-spectrum antibiotic therapy, which was suspended after blood and sputum cultures excluded bacterial superinfection. Subsequently, he showed progressive improvement in muscle strength, pain, enzyme levels, resolution of electrolyte disturbances and stabilisation of renal function. However, he showed further impairment in respiratory condition and died during admission. Solis JG, et al. Case report: Rhabdomyolysis in a patient with COVID-19: A proposed diagnostic-therapeutic algorithm. American Journal of Tropical Medicine and Hygiene 803516042 103: 1158-1161, No. 3, Sep 2020. Available from: URL: http://doi.org/10.4269/ajtmh.20-0692
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Reactions 21 Nov 2020 No. 1831
