Anesth Analg 2005;100:898
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000146653.68648.0E
LETTER TO THE EDITOR
Rhabdomyolysis Associated with Crohn’s Disease, Probably Mediated by Myositis
Tomohiro Matsuda, MD,
Satoki Inoue, MD, and
Hitoshi Furuya, MD
Department of Anesthesiology; Nara Medical University; Nara, Japan; seninoue{at}naramed-u.ac.jp
To the Editor:
We managed a case of Crohn’s disease accompanied by rhabdomyolysis, which had not been initially recognized as an extraintestinal complication.
A male patient with a several-year history of Crohn’s disease developed rhabdomyolysis twice before the scheduled surgery, which resulted in postponement each time. Drug-induced rhabdomyolysis (because of famotidine for the first time and saccharated ferric oxide for the second time) was initially suspected. However, we highly suspected that he had suffered from myositis after the neurological findings from electromyographic examination. Consequently, it was recognized that he had Crohn’s disease accompanied with rhabdomyolysis due to myositis. Two months had passed since his admission when a total colectomy was performed under general anesthesia. The anesthetic management was not eventful. After the colectomy, clinical symptoms of myositis were not observed.
Crohn’s disease is known to involve various extraintestinal complications, but muscular complications are extremely rare (1). Thus, muscular lesions might not be recognized as its extraintestinal complications. Actually, it was difficult to conceive that this myositis could be one of the extraintestinal complications of Crohn’s disease, because no anesthetic literature provided such information. However, Crohn’s disease accompanied with myositis manifesting hyper-creatinine phosphokinase (CPK)-emia has been reported (2,3). Hayashi and coworkers suggested that the extraintestinal complications may have a common immunologic origin (2), which might imply that the treatments for Crohn’s disease may be effective for this type of myositis. Rose et al. also reported two cases with sustained myoglobinuria that did not resolve with supportive treatment (4). After establishment of the diagnosis of dermatomyositis, specific therapy for myositis also resolved their myoglobinuria. In our case, the suspicion of drug-induced rhabdomyolysis delayed the specific treatments for Crohn’s disease including medication and surgery, which could have been most effective to resolve this rhabdomyolysis until establishment of the diagnosis. We believe that this case report will contribute to the knowledge of a relationship between Crohn’s disease and rhabdomyolysis for anesthesiologist and therapeutic implications.
References
- Greenstein AJ, Janowitz HD, Sachar DB. The extra-intestinal complications of Crohn’s disease and ulcerative colitis: a study of 700 patients. Medicine (Baltimore) 1976;55:401–12.[Medline]
- Hayashi K, Kurisu Y, Ohshiba S, et al. Report of a case of Crohn’s disease associated with hyper-creatine phosphokinase-emia. Jpn J Med 1991;30:441–5.[Medline]
- Chiba M, Igarashi K, Ohta H, et al. Rhabdomyolysis associated with Crohn’s disease. Jpn J Med 1987;26:255–60.[Medline]
- Rose MR, Kissel JT, Bickley LS, Griggs RC. Sustained myoglobinuria: the presenting manifestation of dermatomyositis. Neurology 1996;47:119–23.[Abstract/Free Full Text]
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