Dr. Asad A Riyaz : Acute Myositis with Rhabdomyolysis, Acute Kidney Injury (AKI) and Dying Back Diabetic Polyneuropathy

Patient Information

• Name:Mrs.MumtazJahan
• Age:67 years old
• Gender:Female

Presenting Complaints

Mrs.MumtazJahan, a 67-year-old lady, presented with complaints of pain in both legs and pelvic region, loss of appetite, nausea, vomiting, and constipation for the past 10 days. These symptoms had progressively worsened, leading to her seeking medical attention.

Medical History

The patient has a known history of Coronary Artery Disease (CAD) with Triple Vessel Disease (TVD) and had previously undergone Percutaneous Transluminal Coronary Angioplasty (PTCA) for her heart condition. She had no other significant comorbidities reported.

Clinical Findings

Upon admission, the patient was evaluated for her complaints, and significant findings included generalized muscle pain, particularly in the pelvic and lower limb regions. There were signs of dehydration and a decreased urinary output.

Diagnosis

The patient was diagnosed with Acute Myositis complicated by Rhabdomyolysis and Acute Kidney Injury (AKI), presenting as anuric with hyperkalemia. This condition required immediate intervention with hemodialysis due to the severity of renal involvement.

Investigations

• Ultrasound (USG) of the Whole Abdomen
  Revealed Grade 1 fatty liver changes.
• Urine Culture
  No bacterial growth, indicating no urinary tract infection.
• Electromyography (EMG) / Nerve Conduction Velocity (NCV) Study
  Confirmed Dying Back Diabetic Polyneuropathy, which explained the sensory and motor deficits in the patient's lower limbs.
• Blood Tests:
  • Elevated creatine kinase (CK) and myoglobin levels, consistent with Rhabdomyolysis.
  • Electrolyte imbalances, including hyperkalemia, due to muscle breakdown and renal impairment.

Management

The patient was managed with a multi-pronged approach, including:

• Intravenous Fluid Resuscitation
  To combat dehydration and support renal function.
• Medications
  A combination of analgesics, antiemetics, and supportive care.
• Hemodialysis (HD)
  Two sessions of hemodialysis were conducted through a right triple-lumen HD catheter to manage the AKI, hyperkalemia, and to facilitate the removal of metabolic waste products.
• Diabetic Management
  Given the findings of diabetic polyneuropathy, the patient was continued on her diabetes treatment plan, including optimal glucose control.

Complications and Management

The patient developed ulceration on the lateral borders of the tongue, which was managed under the care of Dr. Asad Riyaz. The patient responded well to treatment, with gradual improvement in symptoms over time.

Outcome

The patient showed significant improvement with the combination of hemodialysis and appropriate pharmacological treatment. Her kidney function started to recover post-dialysis, and her pain in the pelvic region and lower limbs began to subside. The ulcer on the tongue also healed with continued treatment under the supervision of Dr. Asad Riyaz.

Conclusion

This case highlights the complex interplay between multiple comorbidities, including acute myositis, rhabdomyolysis, diabetic polyneuropathy, and acute kidney injury in an elderly patient with a history of coronary artery disease. Early recognition of these conditions and prompt intervention, including hemodialysis, is crucial for preventing further complications and ensuring recovery. Regular monitoring of renal function, electrolytes, and muscle enzymes is essential in managing such patients effectively.