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Muscle Involvement in Acute Rhabdomyolysis

Charles B. Porter, MD; Daniel R. Hinthorn, MD; Guillermo Couchonnal, MD; Itaru Watanabe, MD; E. Anne Caveny, MD; Barry Goldman, MD; Ray Lash, MD; Fred Holmes, MD; Chien Liu, MD

JAMA. 1981;245(15):1545-1547.

Abstract
Streptococci seldom invade muscle in healthy people with intact integument. However, infection with another agent simultaneously may change this general observation. In a two-week period we encountered dual infections with group A, β-hemolytic streptococci and a picornavirus in each of two hospitalized patients. Both were acutely ill; one died. Renal failure developed in the patient who survived and rhabdomyolysis was demonstrated in the patient who died. Picornavirus titer increases were demonstrated in the patient who survived, and viral inclusions in muscle cells were demonstrated by light microscopy in necropsy specimens and confirmed by electron microscopy in the second patient. We believe that streptococcal invasion of muscle may be facilitated during an outbreak of certain picornavirus infections.

(JAMA 1981;245:1545-1547)

Author Affiliations
From the Departments of Internal Medicine (Drs Porter, Hinthorn, Couchonnal, Goldman, Lash, Holmes, and Liu) and Pathology (Drs Watanabe and Caveny), the University of Kansas Medical Center College of Health Sciences and Hospital, Kansas City.

Footnotes
Reprint requests to Department of Medicine, University of Kansas Medical Center College of Health Sciences and Hospital, Kansas City, KS 66103 (Dr Hinthorn).

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