P18 | A case of rhabdomyolysis induced by clarithromycin

Background: Rhabdomyolysis (Rha) is a clinical and laboratory syndrome caused by various etiologies, involving the skeletal muscle. Rha is induced by clarithromycin has been described only in few previous reports. Case report: A 82-year-old Caucasian female was admitted to Livorno Hospital for fever. The chest x-ray showed signs of pneumonia associate. She had allergy to penicillin and the first antibiotic therapy was made with macrolide: clarithromycin. After two days the patient referred muscle pain. At the first moment we thought that was only a sign of general infection but the pain was too strong so we repeated blood exams including complete blood cell count, thyroid hormones, liver and muscle(creatine kinase [CK], myoglobin) enzymes, The exams revealed a huge myoglobin increase(900 ng/mL); 7 times the upper normal range[28–138 ng/mL]) with a mild creatinine increase (1.9 mg/dl), in the absence of others alterations. We observed also urine color concomitantly changed toward dark brown. A diagnosis of Rha was made and clarithromycin was stopped, while the concomitant therapy was continued. The patient was immediately treated with intravenous crystalloid hypotonic solution and corticosteroid. Although the renal function we administer levofloxacin. Myoglobin levels decreased within a few days. Conclusions: The patient was discharged home on the seven hospital day with the diagnosis of iatrogenic Rha and acquired pneumonia.