Pravastatin-induced rhabdomyolysis and purpura fulminans in a patient with chronic renal failure.
Pravastatin-induced rhabdomyolysis and purpura fulminans in a patient with chronic renal failure.
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DOI：
10.1016/j.ijscr.2015.01.042
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发表时间：
2015
影响因子：
0.6
通讯作者：
Furukawa, Hiroyuki
中科院分区：
文献类型：
--
作者：
Kato, Kazuya;Onodera, Kazuhiko;Iwasaki, Yoshiaki;Matsuda, Minoru;Kawakami, Takako;Higuchi, Mineko;Kato, Kimitaka;Kato, Yurina;Taniguchi, Masahiko;Furukawa, Hiroyuki
普伐他汀单药治疗与慢性肾功能衰竭患者横纹肌溶解的潜在致死性副作用相关。暴发性紫癜伴指坏疽的发病机制尚不清楚，一般认为与DIC的发生有关。我们报告一个极为罕见的病例，普伐他汀诱导横纹肌溶解症和暴发性紫癜DIC的慢性肾功能衰竭患者。这是第一次报告普伐他汀单药治疗导致横纹肌溶解症的多裂肌和暴发性紫癜DIC。与使用普伐他汀相关的横纹肌溶解症已被证明是他汀类药物的一种罕见但可能危及生命的不良反应。在此，我们报告一例罕见的横纹肌溶解症和暴发性紫癜的患者谁曾使用普伐他汀和发展慢性肾功能衰竭（CRF），需要开始透析。我们报告一位86岁男性慢性肾脏病患者，因背痛入院接受透析治疗。他被处方并服用普伐他汀治疗高脂血症近3年。他在就诊前接受了7次血液透析治疗。实验室检查值包括血清肌酸浓度为6.6 mg/dl，肌酐磷酸激酶（CPK）浓度为2350 IU/L。腹部计算机断层扫描显示肌肉肿胀，多裂肌中肌肉密度和空气密度降低。入院后2天，患者背部、腹部和上下肢出现大面积、压痛性瘀斑和紫癜性进行性皮肤坏死。患者在首次入院后6天死于弥散性血管内凝血（DIC）。根据这些发现和临床病史，诊断为普伐他汀诱导的横纹肌溶解症和暴发性紫癜。长期使用他汀类药物治疗和因ESRD开始透析治疗，随后在6天内快速发生横纹肌溶解，表明他汀类药物浓度升高。我们报告一个极为罕见的病例，普伐他汀诱导横纹肌溶解症和暴发性紫癜DIC的慢性肾功能衰竭患者。
Pravastatin monotherapy is associated with the potentially fatal side effect of rhabdomyolysis in a patient with chronic renal failure. The pathogenesis of purpura fulminans with digital gangrene is unclear and thought to be related to the development of DIC. We report an extremely rare case of pravastatin-induced rhabdomyolysis and purpura fulminans with DIC in a patient with CRF. This is the first report of pravastatin monotherapy resulting in rhabdomyolysis of the multifidus muscle and purpura fulminans with DIC. Rhabdomyolysis associated with the use of pravastatin has been demonstrated to be a rare but potentially life-threatening adverse effect of statins. Here, we report a rare case of rhabdomyolysis and purpura fulminans in a patient who had used pravastatin and developed chronic renal failure (CRF) necessitating the initiation of dialysis. We present the case of an 86-year-old man with chronic kidney disease (CKD) treated with dialysis who was admitted with back pain. He was prescribed and took pravastatin for almost 3 years to treat hyperlipidemia. He received hemodialysis therapy 7 times prior to presentation. Laboratory values included a serum creatine concentration of 6.6 mg/dl and a creatinine phosphokinase (CPK) concentration of 2350 IU/L. An abdominal computed tomography scan showed swollen muscles with reduced muscle density and air density in the multifidus muscle. Two days after admission, he had large, tender ecchymotic lesions and purpuric progressive skin necrosis over the back, abdomen, and upper and lower extremities. The patient died 6 days after the initial admission due to disseminated intravascular coagulation (DIC). Based on these findings and the clinical history, a diagnosis of pravastatin-induced rhabdomyolysis and purpura fulminans was made. The long-term use of statin therapy and the initiation of dialysis therapy due to ESRD, followed by a rapid onset of rhabdomyolysis within 6 days, is indicative of an elevated statin concentration. We report an extremely rare case of pravastatin-induced rhabdomyolysis and purpura fulminans with DIC in a patient with CRF.