title: Rhabdomyolysis associated with initiation of febuxostat therapy for hyperuricaemia in a patient with chronic kidney disease.
abstract: OBJECTIVE
  Febuxostat is now recommended as the first-line pharmacological urate-lowering therapy for gout in the American College of Rheumatology guidelines. There is no case of rhabdomyolysis associated with febuxostat among reported side effects of the drug. Our objective is to report on a case of rhabdomyolysis associated with initiation of febuxostat in a patient with chronic kidney disease (CKD).
  
  
  METHODS
  A 73-year-old male patient visited our emergency room due to progressive weakness in both lower extremities starting 3 days earlier. Ten days before presentation, his primary physician had changed his prescription from allopurinol to febuxostat (80 mg) because of poor control of uric acid levels. There was tenderness in both thighs. Initial creatinine kinase (CK) was 7652 U/L (0-170 U/L), and a bone scan using (99m) Tc-HDP revealed strong uptake in soft tissues in both thighs and buttocks. Electromyography (EMG) and nerve conduction velocity (NCV) showed abnormal spontaneous activities (ASA), suggesting myopathy, not nerve damage. On day 7 of admission, after conservative management and febuxostat withdrawal, he could walk on the ward. He is being followed in our clinic as an outpatient with no sequelae.
  
  
  CONCLUSIONS
  This report is first case of rhabdomyolysis associated with initiation of febuxostat. Febuxostat should be withdrawn when rhabdomyolysis is confirmed.
authors.affiliation: Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea.
authors.forename: Y
authors.initials: Y
authors.lastname: Kang
authors.forename: M J
authors.initials: MJ
authors.lastname: Kim
authors.forename: H N
authors.initials: HN
authors.lastname: Jang
authors.forename: E J
authors.initials: EJ
authors.lastname: Bae
authors.forename: S
authors.initials: S
authors.lastname: Yun
authors.forename: H S
authors.initials: HS
authors.lastname: Cho
authors.forename: S-H
authors.initials: SH
authors.lastname: Chang
authors.forename: D J
authors.initials: DJ
authors.lastname: Park
mesh_terms: D000368:Aged; D000069465:Febuxostat; D006073:Gout / Q000188:drug therapy / Q000453:epidemiology; D006074:Gout Suppressants / Q000009:adverse effects*; D006801:Humans; D033461:Hyperuricemia / Q000188:drug therapy*; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012206:Rhabdomyolysis / Q000139:chemically induced*; D013844:Thiazoles / Q000009:adverse effects*
chemical_list: D006074:Gout Suppressants; D013844:Thiazoles; D000069465:Febuxostat
keywords: chronic kidney disease; febuxostat; rhabdomyolysis