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Allen B. Kaiser, MD; Dwaine Rieves, MD; Ann H. Price, MD; Michael R. Gelfand, MD; Richard E. Parrish, MD; Michael D. Decker, MD; Martin E. Evans, MD

JAMA. 1985;253(2):241-243.

Abstract
Rhabdomyolysis as a complication of tularemia occurred in four patients in Tennessee over a four-year period. All patients were severely ill and had renal failure. Tularemia was not suspected initially in any of these patients. One patient died of complications of rhabdomyolysis. At autopsy, multiple abscesses were present within skeletal muscle, suggesting that rhabdomyolysis resulted from direct muscle involvement with Francisella tularensis. Tularemia should be considered in the differential diagnosis of patients with an acute febrile illness and rhabdomyolysis. Conversely, in patients with acute tularemia, the possibility of rhabdomyolysis should be entertained early, especially in those with evidence of myoglobinuria and/or impaired renal function.

(JAMA 1985;253:241-243)

Author Affiliations
From the Departments of Medicine (Drs Kaiser, Rieves, Price, and Evans), St Thomas Hospital and Vanderbilt University School of Medicine, Nashville; the Methodist Hospitals, Memphis (Dr Gelfand); the University of Tennessee Center for the Health Sciences, Memphis (Dr Parrish); and the Field Services Division, Epidemiology Program Office, Centers for Disease Control, Atlanta (Dr Decker).

Footnotes
Reprint requests to Department of Medicine, St Thomas Hospital, PO Box 380, Nashville, TN 37202 (Dr Kaiser).

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