Rhabdomyolysis in Scrub Typhus: An Unusual Presentation
A 50-year-old male, farmer by occupation presented with a history of high grade fever for 8 days with pain in the calf and thigh muscle region for 4 days, pedal edema, and decreased urine output for 1 day. There was no history of rash, cough, jaundice or history suggestive of urinary tract infection. Patient presented to a rural tertiary care institute with a history of treatment for 2 days at a local health center and the details of treatment were not available at the time of presentation to our institute. Later the details of treatment given at local health center revealed that, patient had received a course of antimalarial (Chloroquine), analgesics and intravenous fluids. Patient was referred to our institute in view of persisting fever and hematuria. At the time of presentation, patient had myoglobinuria []. On examination, pulse was 90 beats/min, blood pressure was 130/80 mm Hg and there were no signs of pallor, icterus, clubbing or lymphadenopathy. The eschar was seen in the right medial aspect of the shoulder [] and there was bilateral pitting pedal edema. The systemic examination was within the normal limits.\nThe details of laboratory examination are shown in .\nThe renal parameters were deranged and the muscle enzyme creatine phosphokinase total was elevated. The liver function tests were normal. The complete hemogram showed a normal total leukocyte and platelet count and no malarial parasites. Electrocardiogram revealed tall-tented T waves with a rate of 88 beats/min. The chest X-ray and ultrasonography of the abdomen were normal. The blood and urine culture were sterile. The Widal test leptospira, and dengue serology were negative.\nIn view of rhabdomyolysis and ARF, urgent hemodialysis was planned. Meanwhile, patient was started on doxycycline 100 mg and received treatment for hyperkalemia. The repeat sample for potassium after correction revealed a value of 7 mE/l. In view of persistent hyperkalemia patient was immediately taken to hemodialysis. However, within 2 h of hospital admission, patient sustained cardiac arrest probably due to hyperkalemia and could not be revived with cardiopulmonary resuscitation.