Deep vein thrombosis and localized rhabdomyolysis in a patient with bladder cancer

Det norske radiumhospital HF 0310 Oslo.
Tidsskrift for Den norske legeforening 11/2002; 122(26):2534-5.
Source: PubMed


Rhabdomyolysis is caused by skeletal muscle injury that results in the release of intracellular contents into the circulatory system. In certain cases, potentially fatal conditions may develop. Multiple conditions followed by muscular necrosis may lead to rhabdomyolysis.
We present a case history of a patient with bladder cancer in whom deep vein thrombosis was complicated by rhabdomyolysis. The patient developed acute renal failure. We have also searched the literature for similar cases.
The patient did not respond to the treatment given. In order to save his life, the affected extremity was amputated. Rhabdomyolysis is a very rare complication of deep vein thrombosis. There are only a few patients described in the literature in which these conditions occur simultaneously. The diagnosis of rhabdomyolysis can easily be missed, as the two conditions give almost identical symptoms.

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    • "Given a serum half-life of 1.5 days for CK [21], it seems unlikely that the CK elevation is attributable to an exercise regimen discontinued 9 days earlier. Although rhabdomyolysis can be caused by localized DVT [22,23] (or, alternatively, can mimic it [24]), this appears to be highly unusual with Paget-Schroetter syndrome, as we could identify only 1 such case reported in the literature [25]. "
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    ABSTRACT: Background Thrombotic events in otherwise healthy pediatric patients are rare. In patients presenting with limb swelling, thrombosis must be considered in the differential diagnosis. In pediatric patients with thrombosis, there has been wide variability in the rates of associated thrombophilia. Many pediatric patients may instead have other contributors such as venous catheters or physical activity. Case Report We present a case of bilateral upper extremity deep venous thrombi in a previously healthy 16-year-old male. The patient presented with swelling and pain in both arms after several days of weight-bearing exercise. Following emergency department evaluation with ultrasound and laboratory testing, the patient was diagnosed with effort thrombosis - also known as Paget-Schroetter syndrome - and rhabdomyolysis. Conclusions This case of Paget-Schroetter syndrome is distinguished by elevation in creatine kinase and transaminases. While these findings can be due to physical exertion and effort, effort thrombosis is not classically associated with laboratory abnormalities except an elevated D-dimer. The significance of these laboratory test result abnormalities remains unclear. Given the rarity of effort thrombosis, further epidemiological study is warranted to determine if these laboratory findings are seen in other cases, and, if so, what implications they may have for management and prognosis.
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