Pravastatin-induced rhabdomyolysis and purpura fulminans in a patient with chronic renal failure

Kazuya Kato, Kazuhiko Onodera, Yoshiaki Iwasaki, Minoru Matsuda, Takako Kawakami, Mineko Higuchi, Kimitaka Kato, Yurina Kato, Masahiko Taniguchi, Hiroyuki Furukawa

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction Rhabdomyolysis associated with the use of pravastatin has been demonstrated to be a rare but potentially life-threatening adverse effect of statins. Here, we report a rare case of rhabdomyolysis and purpura fulminans in a patient who had used pravastatin and developed chronic renal failure (CRF) necessitating the initiation of dialysis. Presentation of case We present the case of an 86-year-old man with chronic kidney disease (CKD) treated with dialysis who was admitted with back pain. He was prescribed and took pravastatin for almost 3 years to treat hyperlipidemia. He received hemodialysis therapy 7 times prior to presentation. Laboratory values included a serum creatine concentration of 6.6 mg/dl and a creatinine phosphokinase (CPK) concentration of 2350 IU/L. An abdominal computed tomography scan showed swollen muscles with reduced muscle density and air density in the multifidus muscle. Two days after admission, he had large, tender ecchymotic lesions and purpuric progressive skin necrosis over the back, abdomen, and upper and lower extremities. The patient died 6 days after the initial admission due to disseminated intravascular coagulation (DIC). Based on these findings and the clinical history, a diagnosis of pravastatin-induced rhabdomyolysis and purpura fulminans was made. Discussion The long-term use of statin therapy and the initiation of dialysis therapy due to ESRD, followed by a rapid onset of rhabdomyolysis within 6 days, is indicative of an elevated statin concentration. Conclusion We report an extremely rare case of pravastatin-induced rhabdomyolysis and purpura fulminans with DIC in a patient with CRF.

Original languageEnglish
Pages (from-to)84-87
Number of pages4
JournalInternational Journal of Surgery Case Reports
Volume8
DOIs
Publication statusPublished - 2015

Fingerprint

Purpura Fulminans
Pravastatin
Rhabdomyolysis
Chronic Kidney Failure
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Dialysis
Disseminated Intravascular Coagulation
Muscles
Paraspinal Muscles
Creatine
Back Pain
Hyperlipidemias
Chronic Renal Insufficiency
Abdomen
Renal Dialysis
Lower Extremity
Creatinine
Necrosis
Phosphotransferases
Therapeutics

Keywords

  • Chronic renal failure (CRF)
  • Dialysis
  • Disseminated intravascular coagulation (DIC)
  • Pravastatin
  • Purpura fulminans
  • Rhabdomyolysis

ASJC Scopus subject areas

  • Surgery

Cite this

Pravastatin-induced rhabdomyolysis and purpura fulminans in a patient with chronic renal failure. / Kato, Kazuya; Onodera, Kazuhiko; Iwasaki, Yoshiaki; Matsuda, Minoru; Kawakami, Takako; Higuchi, Mineko; Kato, Kimitaka; Kato, Yurina; Taniguchi, Masahiko; Furukawa, Hiroyuki.

In: International Journal of Surgery Case Reports, Vol. 8, 2015, p. 84-87.

Research output: Contribution to journalArticle

Kato, K, Onodera, K, Iwasaki, Y, Matsuda, M, Kawakami, T, Higuchi, M, Kato, K, Kato, Y, Taniguchi, M & Furukawa, H 2015, 'Pravastatin-induced rhabdomyolysis and purpura fulminans in a patient with chronic renal failure', International Journal of Surgery Case Reports, vol. 8, pp. 84-87. https://doi.org/10.1016/j.ijscr.2015.01.042
Kato, Kazuya ; Onodera, Kazuhiko ; Iwasaki, Yoshiaki ; Matsuda, Minoru ; Kawakami, Takako ; Higuchi, Mineko ; Kato, Kimitaka ; Kato, Yurina ; Taniguchi, Masahiko ; Furukawa, Hiroyuki. / Pravastatin-induced rhabdomyolysis and purpura fulminans in a patient with chronic renal failure. In: International Journal of Surgery Case Reports. 2015 ; Vol. 8. pp. 84-87.
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T1 - Pravastatin-induced rhabdomyolysis and purpura fulminans in a patient with chronic renal failure

AU - Kato, Kazuya

AU - Onodera, Kazuhiko

AU - Iwasaki, Yoshiaki

AU - Matsuda, Minoru

AU - Kawakami, Takako

AU - Higuchi, Mineko

AU - Kato, Kimitaka

AU - Kato, Yurina

AU - Taniguchi, Masahiko

AU - Furukawa, Hiroyuki

PY - 2015

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N2 - Introduction Rhabdomyolysis associated with the use of pravastatin has been demonstrated to be a rare but potentially life-threatening adverse effect of statins. Here, we report a rare case of rhabdomyolysis and purpura fulminans in a patient who had used pravastatin and developed chronic renal failure (CRF) necessitating the initiation of dialysis. Presentation of case We present the case of an 86-year-old man with chronic kidney disease (CKD) treated with dialysis who was admitted with back pain. He was prescribed and took pravastatin for almost 3 years to treat hyperlipidemia. He received hemodialysis therapy 7 times prior to presentation. Laboratory values included a serum creatine concentration of 6.6 mg/dl and a creatinine phosphokinase (CPK) concentration of 2350 IU/L. An abdominal computed tomography scan showed swollen muscles with reduced muscle density and air density in the multifidus muscle. Two days after admission, he had large, tender ecchymotic lesions and purpuric progressive skin necrosis over the back, abdomen, and upper and lower extremities. The patient died 6 days after the initial admission due to disseminated intravascular coagulation (DIC). Based on these findings and the clinical history, a diagnosis of pravastatin-induced rhabdomyolysis and purpura fulminans was made. Discussion The long-term use of statin therapy and the initiation of dialysis therapy due to ESRD, followed by a rapid onset of rhabdomyolysis within 6 days, is indicative of an elevated statin concentration. Conclusion We report an extremely rare case of pravastatin-induced rhabdomyolysis and purpura fulminans with DIC in a patient with CRF.

AB - Introduction Rhabdomyolysis associated with the use of pravastatin has been demonstrated to be a rare but potentially life-threatening adverse effect of statins. Here, we report a rare case of rhabdomyolysis and purpura fulminans in a patient who had used pravastatin and developed chronic renal failure (CRF) necessitating the initiation of dialysis. Presentation of case We present the case of an 86-year-old man with chronic kidney disease (CKD) treated with dialysis who was admitted with back pain. He was prescribed and took pravastatin for almost 3 years to treat hyperlipidemia. He received hemodialysis therapy 7 times prior to presentation. Laboratory values included a serum creatine concentration of 6.6 mg/dl and a creatinine phosphokinase (CPK) concentration of 2350 IU/L. An abdominal computed tomography scan showed swollen muscles with reduced muscle density and air density in the multifidus muscle. Two days after admission, he had large, tender ecchymotic lesions and purpuric progressive skin necrosis over the back, abdomen, and upper and lower extremities. The patient died 6 days after the initial admission due to disseminated intravascular coagulation (DIC). Based on these findings and the clinical history, a diagnosis of pravastatin-induced rhabdomyolysis and purpura fulminans was made. Discussion The long-term use of statin therapy and the initiation of dialysis therapy due to ESRD, followed by a rapid onset of rhabdomyolysis within 6 days, is indicative of an elevated statin concentration. Conclusion We report an extremely rare case of pravastatin-induced rhabdomyolysis and purpura fulminans with DIC in a patient with CRF.

KW - Chronic renal failure (CRF)

KW - Dialysis

KW - Disseminated intravascular coagulation (DIC)

KW - Pravastatin

KW - Purpura fulminans

KW - Rhabdomyolysis

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