The use of extracorporeal life support in the treatment of influenza-associated myositis/rhabdomyolysis

Abstract

A 13-year-old girl presented to the emergency department with fatigue, headaches and muscle stiffness after returning from a family camping trip. Within 24 h, she was transferred to ICU with general oedema and low saturations, where she had a cardio-respiratory arrest and was placed on veno-arterial extracorporeal membrane oxygenation (ECMO). The patient was successfully supported with ECMO for profound myocardial dysfunction and haemofiltration for rhabdomyolysis and acute renal failure.

Patients who present with profound myocardial dysfunction and myoglobinuria as a consequence of viral infection can be successfully supported with ECMO.

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References

Karjalainen J , Nieminen MS. A1 Myocarditis in conscripts . Acta Med Scand 1980; 207: 27-30 .

Bandt CM , Staley NA , Noren GR. Acute viral myocarditis: clinical and histological changes . Minn Med 1979; 62: 234-237 .

Nicholson KG. Human influenza. In Nicholson KG , Webster R , Hay A eds. Textbook of influenza. Blackwell Science , 1997: 219-263.

Mohler ER 3rd , Ryan T , Segas DS et al. Clinical utility of troponin T levels and echocardiography in the emergency department . Am Heart J 1998; 135: 253-260 .

Greaves K , Oxford J , Price CP , Clarke GH , Crake T. The prevalence of myocarditis and skeletal muscle injury during acute viral infection in adults: measurements of cardiac troponins I and T in 152 patients with acute influenza infection . Arch Intern Med 2003; 163(2): 165-168 .

Horton S , Thuys C , Bennett M , Auguetius S , Rosenberg M , Brizorok C. Experience with the Jostra Rotaflow and QuadroxD oxygenator for ECMO . Perfusion 2004; 19: 17-23 .

Pina EM , Mehlam CT. Rhabdomyolysis. A primer for the orthopaedist . Orthop Rev 1994; 23(1): 28-32 .

Swaringen JC , Seiler JG 3rd , Bruce RW Jr. Influenza A induced rhabdomyolysis resulting in extensive compartment syndrome . Clin Orthopaed Rel Res 2000; 1(375): 243-249 .

Ceneviva G , Paschal JA , Maffei F , Carcillo JA. Haemodynamic support in fluid refractory pediatric shock . Pediatrics 1998; 102: e19-e19 .

10.

Libby P , Simon D. Inflammation and thrombosis: the clot thickens . Circulation 2001; 103: 1718-1720 .

11.

Levi M , van der Poll T , Büller H. Bidirectional relation between inflammation and coagulation . Circulation 2004; 109: 2698-2704 .

12.

Kozek-Langenecker S. Anticoagulation with prostaglandins during extracorporeal circulation . Wien Klin Wochenschr 1999; 111/4: 129-140 .

13.

Nolte K , Alakija P , Oty G et al. Influenza A virus infection complicated by fatal myocarditis . Am J Forensic Med Pathol 2000; 21(4): 375-379 .

14.

Agyeman P , Duppenthaler A , Heiminger U , Aebi C. Influenza-associated myositis in children . Infection 2004; 32(4): 4-5 .