Pediatric Rhabdomyolysis and Plasmapheresis - A Review of Two Cases




Abdali, Kulsum
Tran, Jessica
Hamby, Tyler
Gillespie, Robert


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Background: Rhabdomyolysis is the breakdown of skeletal muscles causing leakage of cellular components like creatine kinase (CK) into the bloodstream. Clear guidelines for managing pediatric rhabdomyolysis currently do not exist. Traditional treatment involves prompt administration of intravenous (IV) fluids to counteract dehydration and prevent acute kidney injury (AKI). However, there have been limited case studies involving plasma exchange to treat severe cases of rhabdomyolysis in pediatrics.

Case Information:

Case 1: A 14-year-old female presented with muscle pain, headache, decreased urine output, and tea-colored urine. Her history included lifting weights and dehydration. Her presenting CK was 281,483 U/L and creatinine was 2.88 mg/dL. She was diagnosed with rhabdomyolysis, AKI, and transaminitis. CK levels rose to 410,000 U/L. On the second day, plasmapheresis was performed, and CK levels decreased after two more treatments. However, creatinine levels continued to increase. Renal biopsy showed acute tubular injury secondary to rhabdomyolysis. Hemodialysis was performed. Upon discharge, creatinine was 2.43 mg/dL, and she no longer required dialysis.

Case 2: An 11-year-old female presented with a respiratory illness for two days. Her CK was 41,671 U/L. She was diagnosed with AKI and rhabdomyolysis induced by COVID-19. Standardized treatments were initiated with no improvement. CK levels reached over 410,000 U/L. Plasmapheresis was then initiated for three days, which lowered the CK levels significantly. Upon completion of plasmapheresis, her CK level dropped down to 40,000 U/L. Her CK levels normalized and her AKI became stable.

Conclusions: Given the risks associated with high CK levels resistant to traditional IV hydration, it is crucial that the levels are brought down quickly to prevent long-term complications such as AKI. Therefore, plasmapheresis may be considered in severe, life-threatening rhabdomyolysis in pediatrics.


Research Appreciation Day Award Winner - Texas College of Osteopathic Medicine, 2023 Pediatric Case Study Award