Rhabdomyolysis and plasmodium falciparum malaria: a case report

Introduction: Rhabdomyolysis in Plasmodium falciparum malaria is reported occasionally in the literature;the pathogenetic mechanism is not clearly understood.A determinat role in skeletal muscle damage is played by red cells sequestration in muscle capillaries and parasite's toxins. Case report: We describe a case of severe malaria complicated with rhabdomyolysis in a 6-year old girl, born in Italy, who presented fever 6 weeks after visiting her relatives in Cameroun. She was transferred from another Hospital to our Paediatric Department with a 6 days history of fever(max 39.2°C),vomiting, olyguria, hypotension, calves and feet edema, generalized muscle pain, weakness and red urine. Blood samples revealed: serum hemoglobin 8.5g/dL, White Blood Cell count 18200/mmc, Platelet count 49000/mmc, C-Reactive Protein 10.75mg/dL, CPK 8178U/L and Creatinine levels 1.51mg/dL. Urine myoglobin was 1884ng/mL; no hemoglobinuria was present. The suspect of myoglobinuria due to Plasmodium falciparum malaria was confirmed by blood smear examination showing low parasitemia. The final diagnosis was acute renal failure induced by rhabdomyolysis. The treatment with Artemisinin derivatives obtained rapid resolution of parasitemia. CPK reached values greater than 25.000 IU. The renal failure and rhabdomyolysis resolved with proper hydration. In the same period her 7-year-old brother and her mother were admitted to the Hospital with malaria infection but they did not present rhabdomyolysis or other important malaria complications. Conclusion: Rhabdomyolysis is an unfrequent malaria complication. Its origin is unclear. Severe myalgia, darkened urine, swelling soft tissues are paradigmatic synthoms of rhabdomyolysis.In our young patient the delayed diagnosis could have influenced the severity of this rare complications of the disease.