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Rhabdomyolysis is a medical condition characterized by the breakdown of skeletal muscle tissue. This breakdown releases a protein called myoglobin into the bloodstream. Myoglobin can be harmful to the kidneys and may lead to kidney damage. Rhabdomyolysis can range from a mild condition with minimal symptoms to a severe and life-threatening situation.
COVID-19
Preger A, Wei R, Berg B, Golomb BA - "COVID-19-associated rhabdomyolysis: A scoping review" Int J Infect Dis 136:115-126 (2023). doi: 10.1016/j.ijid.2023.09.002
https://www.ijidonline.com/article/S120 ... 0/fulltext
"Clinicians should be aware of COVID-19-associated rhabdomyolysis, and caution may be warranted in administering agents that may amplify rhabdomyolysis risk."
(Such agents would include many fluorinated drugs now given routinely.)
COVID Vaccine
Finsterer J, Scorza FA, Almeida AG - "Rhabdomyolysis or Myositis following a SARS-CoV-2 Vaccination" Indian J Radiol Imaging 33(3):428-429 (2023). doi: 10.1055/s-0043-1764143
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10289857/
Ruijters VJ, van der Meulen MFG, van Es MA, Smit T, Hoogendijk JE - "Rhabdomyolysis after COVID-19 Comirnaty Vaccination: A Case Report" Case Rep Neurol 14(3):429-432 (2022). doi: 10.1159/000527599
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9830288/
Pucchio A, Akiva MH, Evangeliou H, Papenburg J, Salvadori MI - "Severe rhabdomyolysis secondary to COVID-19 mRNA vaccine in a teenager" Pediatr Nephrol 38(6):1979-1983 (2023). doi: 10.1007/s00467-022-05808-7.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9676900/
Fluoride
Many fluorinated drugs are known to induce rhabdomyolysis, including fluoroquinolones, fluorinated steroids, statins, etc. Here are a just a few reports.
Kumar S, Joginpally T, Kim D, Yadava M, Norgais K, Laird-Fick HS - "Cardiomyopathy from 1,1-Difluoroethane Inhalation" Cardiovasc Toxicol 16(4):370-3 (2016). doi: 10.1007/s12012-015-9348-5
https://link.springer.com/article/10.10 ... 015-9348-5
"We report a 33-year-old male who developed acute myocardial injury and global hypokinesis along with rhabdomyolysis, acute kidney injury, and fulminant hepatitis after 2 days’ nearly continuous huffing."
Dekhuijzen PN, Decramer M - "Steroid-induced myopathy and its significance to respiratory disease: a known disease rediscovered" Eur Respir J 5(8):997-1003 (1992)
https://pubmed.ncbi.nlm.nih.gov/1426209/
van Balkom RH, van der Heijden HF, van Herwaarden CL, Dekhuijzen PN - "Corticosteroid-induced myopathy of the respiratory muscles" Neth J Med. 45(3):114-22 (1994)
https://pubmed.ncbi.nlm.nih.gov/7969664/
"After treatment with fluorinated steroids, side-effects occur more frequently and are worse compared to treatment with non-fluorinated steroids. Acute myopathy and atrophy are caused by short-term high-dose corticosteroid administration, resulting in rhabdomyolysis, diffuse muscle weakness and severe dyspnoea."
Teng C, Baus C, Wilson JP, Frei CR - "Rhabdomyolysis Associations with Antibiotics: A Pharmacovigilance Study of the FDA Adverse Event Reporting System (FAERS)" Int J Med Sci 16(11):1504-1509 (2019). doi: 10.7150/ijms.38605
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818202/
Bouchard J, De La Pena N, Oleksiuk LM- " Levofloxacin-induced rhabdomyolysis in a patient on concurrent atorvastatin: Case report and literature review" J Clin Pharm Ther 44(6):966-969 (2019). doi: 10.1111/jcpt.13010
https://pubmed.ncbi.nlm.nih.gov/31407828/
Ehelepola NDB, Sathkumara SMBY, Bandara HMPAGS, Kalupahana KLR - "Atorvastatin-Diltiazem Combination Induced Rhabdomyolysis Leading to Diagnosis of Hypothyroidism" Case Rep Med 2017:8383251. doi: 10.1155/2017/8383251
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405347/
Gq/11
- Inositol Trisphosphate (IP3) Pathway:
Gq/11 activation leads to the production of IP3.
IP3 induces the release of calcium ions (Ca2+) from intracellular stores, particularly the endoplasmic reticulum.
- Protein Kinase C (PKC) Pathway:
Gq/11 activation also leads to the generation of diacylglycerol (DAG).
DAG, in combination with Ca2+, activates the enzyme protein kinase C (PKC).
These pathways are involved in a wide range of cellular processes, including muscle contraction, cell growth, secretion, and gene expression. In the context of rhabdomyolysis, the dysregulation of these pathways can contribute to disturbances in calcium homeostasis and other cellular processes that may be associated with the observed muscle damage.
Liantonio A, Giannuzzi V, Cippone V, Camerino GM, Pierno S, Camerino DC - "Fluvastatin and atorvastatin affect calcium homeostasis of rat skeletal muscle fibers in vivo and in vitro by impairing the sarcoplasmic reticulum/mitochondria Ca2+-release system" J Pharmacol Exp Ther 321(2):626-34 (2007) doi: 10.1124/jpet.106.118331
Wu D, Pan J, Zhang D - "Inhibition of PKC-δ reduce rhabdomyolysis-induced acute kidney injury" J Cell Mol Med 26(11):3243-3253 (2022). doi: 10.1111/jcmm.17331
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9170808/
Camerino GM, Musumeci O, Conte E, Musaraj K, Fonzino A, Barca E, Marino M, Rodolico C, Tricarico D, Camerino C, Carratù MR, Desaphy JF, De Luca A, Toscano A, Pierno S - "Risk of Myopathy in Patients in Therapy with Statins: Identification of Biological Markers in a Pilot Study" Front Pharmacol. 8:500 (2017)doi: 10.3389/fphar.2017.00500
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5529355/
Zhang MH - "Rhabdomyolosis and its pathogenesis." World J Emerg Med. 3(1):11-5 (2012) doi: 10.5847/wjem.j.issn.1920-8642.2012.01.002
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129825/
Thyroid
Munankami S, Shrestha M, Amin S, Bajracharya A, Paudel R - "Rhabdomyolysis Secondary to Severe Hypothyroidism Due to Hashimoto's Thyroiditis: A Case Report" Cureus 15(6):e39919 (2023). doi: 10.7759/cureus.39919
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317787/
Saroufim R, Alkotob S, Eugster EA - "Rhabdomyolysis: A Rare Presentation of Hashimoto Thyroiditis in an Adolescent Boy and Review of the Literature" Horm Res Paediatr 96(5):538-541 (2023). doi: 10.1159/000529673
https://pubmed.ncbi.nlm.nih.gov/36780885/
Alshamam MS, Gurung DO, Nso N, Saliaj M, Seitaj A - "Rhabdomyolysis Secondary to Hypothyroidism: Report of a Case" Cureus 13(1):e12746. doi: 10.7759/cureus (2021)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885184/
Lichtstein DM, Arteaga RB - "Rhabdomyolysis associated with hyperthyroidism" Am J Med Sci 332(2):103-105 (2006). doi: 10.1097/00000441-200608000-00012
https://pubmed.ncbi.nlm.nih.gov/16909061/
Comak E, Koyun M, Kiliçarslan-Akkaya B, Bircan I, Akman S - "Severe rhabdomyolysis and acute renal failure in an adolescent with hypothyroidism" Turk J Pediat 53(5):586-9
https://pubmed.ncbi.nlm.nih.gov/22272466/
Xu J, He J, Xu S, Wang R, Peng N, Zhang M - "Gitelman syndrome with Graves' disease leading to rhabdomyolysis: a case report and literature review" BMC Nephrol 24(1):123 (2023) doi: 10.1186/s12882-023-03180-8
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10152583/