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Severe Rhabdomyolysis Caused by Plasmodium vivax Malaria in the Brazilian Amazon

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  • Tropical Medicine Foundation of Amazonas, Manaus, Amazonas, Brazil; University of the Amazonas State, Manaus, Amazonas, Brazil; Nilton Lins University Center, Manaus, Amazonas, Brazil; Faculdade de Medicina, Departamento de Neurologia, University of São Paulo, São Paulo, São Paulo, Brazil

Severe rhabdomyolysis (creatine phosphokinase = 29,400U/L) developed in a 16-year-old boy from Manaus, Brazil, after he started treatment with chloroquine for infection with Plasmodium vivax. Treatment led to myoglobinuria and acute renal failure. After hemodialysis, the patient improved and a muscle biopsy specimen showed no myophosphorylase or deaminase deficiency. This case of rhabdomyolysis associated with P. vivax infection showed no comorbidities. The pathogenesis is still unclear.

Although rhabdomyolysis is generally reported as a complication of Plasmodium falciparum malaria, leading to metabolic and renal complications, it has been reported in a patient with P. vivax infection with myoadenylate deaminase deficiency. We report a case in a patient without typical muscle enzyme deficiencies in which severe rhabdomyolysis developed while the patients was being treated with chloroquine for a confirmed P. vivax infection.

Author Notes

*Address correspondence to Marcus V. G. Lacerda, Fundação de Medicina Tropical do Amazonas, Av. Pedro Teixeira 25, Manaus, Amazonas, 69040-000, Brazil. E-mail: marcuslacerda.br@gmail.com

Authors' addresses: André M. Siqueira, Márcia A. A Alexandre, Maria P. G. Mourão, Valquir S. Santos, Maria G. C. Alecrim, and Marcus V. G. Lacerda, Fundação de Medicina Tropical do Amazonas, Av. Pedro Teixeira 25, Manaus, Amazonas, Brazil, E-mails: amsiqueira@gmail.com, marcialexandre@gmail.com, mpmourao@uol.com.br, valquirsantos@yahoo.com.br, malecrim@niltonlins.br, and marcuslacerda.br@gmail.com. Suely K. Nagahashi-Marie, Faculdade de Medicina, Departamento de Neurologia, Universidade de São Paulo, Av. Dr. Arnaldo, 455 - 4° andar, sala 4110, Sao Paulo, SP, Brazil, E-mail: sknmarie@usp.br.

Reprint requests: Marcus V. G. Lacerda, Fundação de Medicina Tropical do Amazonas, Av. Pedro Teixeira 25, Manaus, Amazonas, 69040-000, Brazil.

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