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Successfully treated dramatic exacerbation of the juvenile dermatomyositis with rhabdomyolysis and acute renal failure in 12-year old boy

Elżbieta Smolewska, Henryka Brózik, Joanna Lipińska, Wanda Stengert, Małgorzata Biernacka-Zielińska, Jerzy Stańczyk

Med Sci Tech 2007; 48(3): CR195-198

ID: 881568


Introduction: Juvenile dermatomyositis (DM) is a systemic connective tissue disease characterized by symmetric weakness of the proximal musculature and characteristic cutaneous changes. Renal complications are rarely observed in this disease. Case report: We present the case of 12-year old boy with DM, diagnosed 8 years before, with a history of several exacerbations of the disease. Most recently, he was admitted to our Department in poor general status, with severe weakness of the arm and pelvis girdle musculature. Despite of introduced treatment (methylprednisolone pulses, non steroidal ant-inflammatory drugs, azathioprine), during hospitalization the patient has lost consciousness, with convulsions and symptoms of respiratory insufficiency. Despite of intensive symptomatic treatment, massive rhadomyolysis developed, with significant elevation of both myoglobin and serum muscular-dependent enzyme activity levels as well as myoglobinuria. As a consequence, symptoms of acute renal failure occurred. In this situation, the intravenous immunoglobulin (IVIG) was given at the total dose 1g/kg. As a result of this treatment a systematic clinical improvement has been noticed, with full resolution of laboratory abnormalities. Actually, after 6 months of follow up in the outpatient clinic he remains fully free of symptoms of both the disease and its complications. Conclusions: To our best knowledge, this is the first report describing a case of acute renal failure caused by rhabdomyolysis in the course of exacerbation of juvenile DM. Thus, rhabdmyolysis in children, which is the most frequent complication of trauma, infection or extreme physical exercises, may be also associated with exacerbation of systemic connective tissue diseases, including DM. (Clin Exp Med Lett 2007; 48(3):195-198)

Keywords: dermatomyositis, rhabdomyolysis, acute renal failure, Myoglobin

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