Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
권호 표지

A Case of Exercise-induced Rhabdomyolysis with Hepatitis

간염을 동반한 운동유발성 횡문근융해증 1례

김성아;이채용;정상재;하봉구;박기수

  • Published : 20060300
⟨ Previous Next ⟩

Abstract

Background : Rhabdomyolysis is a relatively rare disease caused by various factors and is characterized by skeletal muscle damage. While crush injury is the most common cause in Korea as well as other countries, overexertion is an important common cause among young men in daily life. Although exercise-induced rhabdomyolysis is already well published among athletes or military persons, there have been few reports in workers. Case report: We observed a 28-year-old male worker who had elevated liver transaminases during a periodic workers’ health checkup. Although he did not exhibit the typical pattern of toxic hepatitis, we had to exclude any possibility of dimethylacetamide-induced hepatitis (DIH) because he had worked in a spandex-producing factory, which already had a history of many DIH cases over several years. We performed careful history taking, several laboratory tests, liver ultrasonography and liver biopsy. We also investigated the results of biological monitoring and air concentrations of dimethylacetamide. The findings from these examinations supported the clinical diagnosis of exercise-induced rhabdomyolysis with hepatitis. Conclusion : This case demonstrates that exercise can induce rhabdomyolysis and hepatitis. This disease must be treated by prompt and appropriate management because it might develop more serious complications such as acute renal failure.

Keywords

References

  1. Akmal M, Massry SG. Reversible hepatic dysfunction associated with rhabdomyolysis. Am J Nephrol 1009;10:49-52 https://doi.org/10.1159/000168053
  2. Bywaters EG, Beall CD. Crush injuries with impairment of renal function. Br Med J 1941;1:427-32 https://doi.org/10.1136/bmj.1.4185.427
  3. Choi JH, Park JJ, Moon CI, Lee JG, Jung WH, Kwon JI, Kim SS, Kang DH, Cho H, Kim JH. A case of rhabdomyolysis associated with salmonellosis. Korean J Gatroenterol 1998;31:392-7. (Korean)
  4. Davis M, Brown R, Dickson A, Horton H, James D, Liang N, Marson R, Norgate M, Perlman D, Pollock N, Stowell K. Malignant hyperthermia associated with exercise-induced rhabdomyolysis or congenital abnormalities and a novel RYR1 mutation in New Zealand and Australian pedigrees. Br J Anaesth 2002;88:508-157 https://doi.org/10.1093/bja/88.4.508
  5. Fernandez WG, Hung O, Bruno R, Galea S, Chiang W. Factors predictive of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis. Am J Emerg Med 2005;23:1-7 https://doi.org/10.1016/j.ajem.2004.09.025
  6. Kim HY, Choi SO, Shin SJ, Kim YK, Han BG, Park SJ, Hong AR, Lee KH. Analysis of 250 cases of rhabdomyolysis. Korean J Nephrol 1994;13:810-7. (Korean)
  7. Kim KG, Kim JH, Kim SM, Chon GR Kim YW, Lee HH, Park SJ, Kim YK, Kim SY, Kim YJ, Cho MK, Lee GJ. Clinical study of rhabdomyolysis developed after the training. Korean J Med 2002;63:675-81. (Korean)
  8. Kim SA, Kim JS, Jeon HR, Jung SJ, Kim SW, Lee C-Y, Ham J-O, Yoo J-Y, Choi T-S, Ha BG Cho M-H, Woo K-Y. Surveillance of work-related diseases in Kumi. Korean J Occup Environ Med 2003;15:95-110. (Korean)
  9. Kim YM, Oh DR, Lee WJ, Kim HG, Hwang DY, Lee H, Choi KH, Jeong SK, Kim SE, Kim YO. 2 Cases of alcoholinduced rhabdomyolysis with acute renal failure. Korean J Emerg Med 1998;4:680-8. (Korean)
  10. Moon CH, Ruy BY, Mo SH, Kim TJ, Kee JD, Park YG, Kim YH, Jeong JH. A case of acute renal failure caused by exercise- related rhabdomyolysis. Med J Chosun Univ 1995;20:88-93. (Korean)
  11. Nomiyama T, Omae K, Ishizuka C, Yamauchi T, Kawasumi Y, Yamada K, Endoh H, Sakurai H. Dermal absorption of N,Ndimethylacetamide in human volunteers. Int Arch Occup Environ Health 2000;73:121-6 https://doi.org/10.1007/s004200050017
  12. Park JW. The diagnosis and treatment of fatty liver. Korean J Hepatol 2001;7:64-70. (Korean)
  13. Rosen CL, Adler JN, Rabban JT, Sethi RK, Arkoff L Blair JA, Sheridan R. Early predictors of myoglobinuria and acute renal failure following electrical injury. J Emerg Med 1999;17:783-9 https://doi.org/10.1016/S0736-4679(99)00084-0
  14. Roth D, Alarcon FJ, Fernandez JA, Preston RA, Bourgoingnie JJ. Acute rhabdomyolysis associated with cocaine intoxication. N Engl J Med 1988;319:673-7 https://doi.org/10.1056/NEJM198809153191103
  15. Sauret JM, Marinides G, Wang GK. Rhabdomyolysis. Am Fam Physician 2002;65:907-12
  16. Sinert R, Kohl L, Rainone T, Scalea T. Exercise-induced rhabdomyolysis. Ann Emerg Med 1994;23:1301-6 https://doi.org/10.1016/S0196-0644(94)70356-6
  17. Wappler F, Fiege M, Antz M, Schulte J. Hemodynamic and metabolic alterations in response to graded exercise in a patient susceptible to malignant hyperthermia. Anesthesiology 2000;92:268-72 https://doi.org/10.1097/00000542-200001000-00042
  18. Wappler F, Fiege M, Steinfath M, Agarwal K, Scholz J, Singh S, Matschke J, Schulte J. Evidence for susceptibility to malignant hyperthermia in patients with exercise-induced rhabdomyolysis. Anesthesiology 2001;94:95-100 https://doi.org/10.1097/00000542-200101000-00019
  19. Ward MM. Factors predictive of acute renal failure in rhabdomyolysis. Arch Intern Med. 1988;148:1553-7 https://doi.org/10.1001/archinte.148.7.1553
  20. Yim HJ, Lee HS, Oh SN, Kim YS, Choi CW, Park CH, Jeen YT, Chun HJ, Um SH, Lee SW, Choi JH, Kim CD, Ryu HS, Hyun JH, Suh Y-L. Two cases of rhabdomyolysis developed in patients with liver cirrhosis. Korean J Gastroenterol 2003;41:509-13. (Korean)