Abstract: SA-PO0350
Atraumatic Rhabdomyolysis in a Critically Ill Patient with Liver Dysfunction
Session Information
- AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Siddiqui, Wasay, University of Illinois Chicago, Chicago, Illinois, United States
- Amarah, Amatur R., University of Illinois Chicago, Chicago, Illinois, United States
Introduction
Rhabdomyolysis is a potentially life threatening syndrome of skeletal muscle breakdown that may arise without trauma in medically complex hospitalized patients, particularly when systemic infection, hepatic dysfunction, renal impairment, and medication exposures coexist.
Case Description
41 year old male with PMH of cirrhosis and portal hypertension status post transjugular intrahepatic portosystemic shunt complicated by biliary fistula to the vascular shunt admitted with ESBL E.Coli bacteremia and started on Meropenem. 48 hours later, the patient complained of diffuse myalgias with CK level rising from 23,404 U/L to 65,614 U/L over the next 24 hours. Differential diagnosis for atraumatic rhabdomyolysis was systemic infection, drug-induced from Atorvastatin and Meropenem. Atorvastatin was discontinued and Meropenem switched to Ceftazidime/Avibactam. Hospital course was complicated by oliguric acute kidney injury with refractory hyperkalemia prompting initiation of dialysis.
Discussion
Atraumatic causes of rhabdomyolysis include drugs, infections, electrolyte abnormalities, endocrinopathies, inflammatory myopathies, and muscular dystrophies, among others. In hospitalized patients, the etiology is often multifactorial: infection, renal and hepatic dysfunction, electrolyte abnormalities, and polypharmacy may converge to lower the threshold for skeletal muscle injury. In this case, concomitant use of atorvastatin in hepatic dysfunction and meropenem was temporally associated with rhabdomyolysis. Pharmacovigilance data have identified a rare but statistically significant association between meropenem and rhabdomyolysis, including a subset of reports with hepatic disorders. This case adds to the limited medical literature on possible meropenem associated rhabdomyolysis and highlights the importance of maintaining a high index of suspicion for multifactorial drug-induced muscle injury in cirrhotic patients exposed to statins, systemic infection, and antibiotics.