Influenza a Infection with Rhabdomyolysis and Acute Renal Failure

A型流感引起橫紋肌溶解症合併急性腎衰竭－病例報告

林承志(Cheng-Chi Lin) ； 簡志峯(Chih-Feng Chian) ； 彭萬誠(Wann-Cherng Perng)

《胸腔醫學》 25卷3期 (2010/06) Pp. 131-136

https://doi.org/10.29806/TM.201006.0004

摘要

目前正當A型流感盛行，流感常表現肌肉酸痛，但真正造成橫紋肌溶解症並不常見。搜尋相關文獻發現流感引起橫紋肌溶解症合併急性腎衰竭只有少數個案報告。我們提出一78歲病患因肌肉酸痛、咳嗽、發燒、持續惡化之下肢疼痛及茶色尿至醫院求診，經小便及血液檢查發現橫紋肌溶解症及腎功能異常，經快篩證實感染A型流感。根據病患病史及臨床表現可推論其橫紋肌溶解症應由A型流感所造成。於治療後病患腎功能及肌酐酸恢復正常且出院。此病例可提醒臨床醫師，當發現病人有橫紋肌溶解症併發急性腎衰竭，A型流感雖不是橫紋肌溶解症併腎衰竭常見致病因，但在此A型流感大流行之際因將其列入考慮。

關鍵字

急性腎衰竭 ； A型流感 ； 橫紋肌溶解症

並列摘要

Influenza A virus can be transmitted widely throughout the community. Although patients with influenza often present with myalgia, rhabdomyolysis is rarely seen. Very few results were obtained in an online search for case reports on rhabdomyolysis and acute renal failure associated with influenza. We present the case of a 78-year-old man who was admitted to our emergency department with myalgia, dry cough, fever, progressive lower limb pain, and tea-colored urine. On investigation, the serum creatine kinase level was found to be elevated and myoglobinuria was detected; these signs were indicative of rhabdomyolysis. Renal function impairment was also noted. Influenza A infection was confirmed by the positive antigen test of a nasal swab. The clinical presentation and medical history of the patient strongly suggested that rhabdomyolysis was caused by influenza A virus. The patient's renal function was restored and he was discharged after appropriate therapy for rhabdomyolysis. This case highlights the importance of recognizing influenza A infection as a cause of acute renal failure secondary to rhabdomyolysis during influenza pandemics, despite the fact that rhabdomyolysis complicated by acute renal failure is rarely seen in patients with influenza A.

並列關鍵字

acute renal failure ； influenza A ； rhabdomyolysis