Fulminant Red Yeast Rice-Associated Rhabdomyolysis with Acute Liver Injury and Hyperkalemia Treated with Extracorporeal Blood Purification Using CytoSorb

Marko Kurnik,1 Tilen Markelj,1 Borut Žgavc,1 Barbara Hudournik,1 Marija Meznarič,2 Matej Podbregar1,2 1Department of Internal Intensive Medicine, General Hospital Celje, Celje, Slovenia; 2Faculty of Medicine, University of Ljubljana, Ljubljana, SloveniaCorrespondence: Marko Kurnik, Department of Internal Intensive Medicine, General Hospital Celje, Oblakova ulica 5, Celje, 3000, Slovenia, Email [email protected]: Rhabdomyolysis is a pathophysiological process characterized by the destruction of muscle cells and the release of intracellular contents into the systemic circulation, which can lead to acute kidney injury (AKI) and failure. Causes are classified mainly as traumatic and non-traumatic, with statin-induced rhabdomyolysis being widely recognized. Other causes are seldomly reported, one being red yeast rice (RYR) or its active ingredient, monacolin K. We present a life-threatening case of fulminant rhabdomyolysis with severe hyperkalemia, accompanied by ECG changes, tetraparesis, impending compartment syndrome, and liver injury requiring intensive care treatment. Prompt renal replacement therapy was commenced, initially for the treatment of hyperkalemia and subsequently for myoglobin adsorption using the CytoSorb membrane. High doses of corticosteroids were administered as the trigger factor was initially unknown. The condition gradually improved, and the patient regained full functionality. The diagnosis of toxic rhabdomyolysis was confirmed only after the patient was discharged from the intensive care unit. An over-the-counter supplement containing red yeast rice (RYR) was identified as the sole possible triggering factor, with symptoms occurring two days after beginning the self-treatment.Keywords: rhabdomyolysis, red yeast rice, monacolin K, intensive care unit, CytoSorb, SLEDD, over-the-counter medications