Severe Rhabdomyolysis Associated with Staphylococcus aureus Acute Endocarditis Requiring Surgery.
BACKGROUND
Rhabdomyolysis has multiple etiologies with unclear mechanisms; however, rhabdomyolysis caused by Staphylococcus aureus infection is rare.


METHODS
A case report of severe rhabdomyolysis in a patient who presented with endocarditis caused by methicillin-susceptible S. aureus and review of relevant literature.


RESULTS
The patient had a history of cardiac surgery for tetralogy of Fallot. He was admitted to the hospital because of fever and digestive symptoms. Respiratory and hemodynamic status deteriorated rapidly, leading to admission to the intensive care unit (ICU) for mechanical ventilation and vasopressor support. Laboratory tests disclosed severe rhabdomyolysis with a serum concentration of creatine kinase that peaked at 49,068 IU/L; all blood cultures grew methicillin-susceptible S. aureus. Antibiotic therapy was amoxicillin-clavulanic acid, ciprofloxacin, and gentamicin initially and was changed subsequently to oxacillin, clindamycin, and gentamicin. Transesophageal echocardiography showed vegetation on the pulmonary valve, thus confirming the diagnosis of acute endocarditis. Viral testing and computed tomography (CT) scan ruled out any obvious alternative etiology for rhabdomyolysis. Bacterial analysis did not reveal any specificity of the staphylococcal strain. The patient improved with antibiotics and was discharged from the ICU on day 26. He underwent redux surgery for valve replacement on day 53.


CONCLUSIONS
Staphylococcal endocarditis should be suspected in cases of severe unexplained rhabdomyolysis with acute infectious symptoms.
1 Medical-Surgical Intensive Care Unit, University Hospital of Limoges , Limoges, France .
Céline
C
Ravry
1 Medical-Surgical Intensive Care Unit, University Hospital of Limoges , Limoges, France .
Anne-Laure
AL
Fedou
1 Medical-Surgical Intensive Care Unit, University Hospital of Limoges , Limoges, France .
Maria
M
Dubos
2 Department of Infectious Diseases, University Hospital of Limoges , Limoges, France .
Éric
É
Denes
3 Department of Cardiology, Emailleurs Private Hospital , Limoges, France .
Caroline
C
Etchecopar
4 Laboratory of Microbiology, University Hospital of Limoges , Limoges, France .
Olivier
O
Barraud
1 Medical-Surgical Intensive Care Unit, University Hospital of Limoges , Limoges, France .
Philippe
P
Vignon
1 Medical-Surgical Intensive Care Unit, University Hospital of Limoges , Limoges, France .
Bruno
B
François
D004697:Endocarditis, Bacterial / Q000150:complications* / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D008297:Male; D012206:Rhabdomyolysis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology*; D013203:Staphylococcal Infections / Q000150:complications* / Q000382:microbiology / Q000601:surgery*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D055815:Young Adult