The presentation of rhabdomyolysis in influenza B patients – a case series
2Faculty of Health Sciences, Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
3Department of Medicine, Sackler School of Medicine, Tel Aviv University
4Boston Children's Hospital, Boston Children's Hospital, Harvard Medical School
5Central Virology, Ministry of Health, Chain Sheba Medical Center
6Department of Epidemiology and Preventive Medicine, School pf Public Health, Sackler Faculty of Medicine
7Internal Medicine Department, Sheba Medical Center
Influenza B-associated rhabdomyolysis is relatively rare. Herein, we describe a retrospective case-series of five children hospitalized in a single institution for rhabdomyolysis from PCR-confirmed Influenza B. Viral sequencing revealed a novel deletion of one amino acid in the viral hemagglutinin, potentially explaining the unusual cluster of cases. Altogether, this work expands current knowledge on Influenza B-associated rhabdomyolysis in children.
Rhabdomyolysis is characterized by muscle necrosis and release of intracellular muscle constituents into the circulation. Typically, patients present with myalgia and elevated creatine kinase (CK) serum levels. In some cases, myoglobinuria may also be present. Disease severity range from asymptomatic to a life-threatening condition associated with electrolyte imbalances and acute kidney injury.
Two main types of etiologic factors have been reported: 1. acquired conditions such as trauma, viral infections, drugs, and toxins; 2. Rare metabolic and neuromuscular monogenic disorders . Viruses that have been linked to rhabdomyolysis include Coxsackie virus , Epstein-Barr virus , Herpes simplex virus and Influenza .
Influenza is an acute respiratory illness caused by influenza A or B viruses, and rarely influenza C virus . Although influenza is usually a self-limited and uncomplicated disease, it can be associated with severe morbidity and mortality among previously healthy individuals. For instance, acute myositis is a rare and severe complication of influenza, whose hallmark is extreme tenderness and swelling of the affected muscles, most commonly the calves. It is characterized by acute skeletal muscle damage, marked elevations in CK and increased risk of AKI.
Notably, the vast majority of influenza-associated rhabdomyolysis reported in the literature are with type A Influenza, while those caused by type B influenza are significantly less common Herein, we report and discuss five pediatric patients who were hospitalized due to influenza B related rhabdomyolysis over a short period of time.