[Acute iatrogenic myopathy during treatment of status asthmaticus. Our experience and review of the literature].
METHODS
A young man was admitted to the ICU for acute asthmatic respiratory failure. He was sedated with propofol, curarized with pancuronium and put on mechanical ventilation for 15 day because of the persistent asthmatics crisis. Drug therapy for asthma included high-dose corticosteroids. When sedation and paralysis were stopped, the patient, that was fully conscious, showed flaccid quadriplegia. A muscular biopsy showed elective loss of the myosin thick filaments. Electrophysiologic evaluation was compatible with both neurologic or muscular pathology. The evolution of the disease was good; a drop-out performed 5 months later showed a complete motor recovery.


CONCLUSIONS
This case report confirms that in some patients, intensive treatment of status asthmaticus may cause myopathy. Only recently this myopathy has been correlated to an interaction between steroids and neuromuscular blockers. Many experimental and clinical observations suggest a negative interaction between steroids and non-depolarizing curare derivatives. In the case reported here, diagnosis was based on electrophysiologic examination and above all on muscular biopsy.


CONCLUSIONS
The occurrence of an acute toxic myopathy should always be taken into account, considering the high number of patients admitted with respiratory failure requiring steroid treatment and curare administrative for mechanical ventilation. It therefore seems reasonable to reduce steroid therapy as soon as possible with a periodic suspension of curare administration. Curare usage should be critically evaluated. Some basic examination such as serum CPK monitoring should allow early detection of muscular damage.
Pacini
D
D
Istituto di Rianimazione, Università degli Studi, Genova.
Ferretti
M
M
Carletti
A
A
Cerana
M
M
De Rito
M
M
Doveri
A
A
Abbruzzese
M
M
Primavera
A
A
Minetti
C
C
D000328:Adult; D006331:Heart Diseases / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D013224:Status Asthmaticus / Q000150:complications* / Q000628:therapy