Case report, case study
https://doi.org/10.21857/90836czwoy
Acute renal failure due to severe rhabdomyolysis provoked by a mild covid-19 infection in patient with LCHAD deficency- a case report
Dunja Leskovar
orcid.org/0000-0002-2342-4450
; Division for Metabolic Diseases, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
*
Dražen Perica
; Division for Metabolic Diseases, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Kristina Paponja
; Division for Metabolic Diseases, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Nediljko Šućur
; Division for Metabolic Diseases, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Željko Reiner
; Division for Metabolic Diseases, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Ivan Pećin
; Division for Metabolic Diseases, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia, University of Zagreb, School of Medicine, Zagreb, Croatia
* Corresponding author.
Abstract
Introduction: LCHAD (long-chain 3-hydroxy-acyl-CoA dehydrogenase) deficiency is an inherited
fatty acid oxidation disorder in which the body is unable to break down certain fats resulting in hypoketotic
hypoglycemia, myopathy, episodic rhabdomyolysis and neuropathy. Metabolic decompensation
is often precipitated by infection or fasting.
Case report: A 26-year-old patient was admitted to the emergency department because of generalized
myalgias. This is a patient with known congenital deficiency of long-chain 3- hydroxy-acyl- CoA
dehydrogenase (LCHAD). He was diagnosed at the age of 3 years and regularly undergoes check-ups
in specialized metabolic department. 10 days prior to the symptoms he had milder form of covid-19
infection with a persistent dry cough. Previously, he was vaccinated with two doses of the mRNA
SARS-COV 2 vaccine. Initially laboratory findings at emergency department showed elevated levels
of creatine kinase (46000 U/L) with normal renal function (egfr: 105 ml/min/1.73m2). Chest X-ray
excluded pneumonia. Abundant hydration with intravenous infusions (0.9% NaCl, 5% glucose) was
started, but during the observation the patient developed oliguria with urine output <10 ml/hour.
Further laboratory findings showed acute kidney injury with worsening rhabdomyolysis (CK>80,000
U/L, egfr: 19 ml/min/1.73m2, creatinine: 369 umol/L). Due to the need for hemodialysis, he was
hospitalized in the intensive care unit where dialysis procedures (CVVHD, CVVHDF) were continuously
performed for 7 days until gradual decrease in creatinine and CK levels. In continuation he was
carefully hydrated with infusions of 10% glucose and received a specially adapted diet to ensure sufficient
caloric intake and to prevent catabolism. In total, he was 12 days on continuous hemodialysis
and the renal function completely recovered after 3 weeks with the normalization of creatinine and CK
values. Beside mild SARS-CoV-2 infection, we haven’t founded any other cause of patient’s metabolic
decompensation.
Conclusion: Patients with LCHAD should be educated and controlled more often in the covid-19
pandemic, as even the mild form of SARS-CoV-2 infection can lead to a rapid metabolic decompensation
and a possible fatal outcome.
Keywords
LCHAD deficiency, rhabdomyolysis, SARS-CoV-2, acute kidney failure
Hrčak ID:
312718
URI
Publication date:
22.12.2023.
Visits: 196 *