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from Part IX - Clinical Syndromes – Musculoskeletal System
Published online by Cambridge University Press: 05 March 2013
Infectious polymyositis is an entity in which there is generalized muscle damage (rhabdomyolysis) caused by an infectious agent. The syndrome of rhabdomyolysis is characterized by elevated serum creatinine phosphokinase (CPK) concentrations and myoglobinuria leading to renal dysfunction. The muscle injury in rhabdomyolysis occurs in a generalized pattern and lacks a specific focus of abscess or infection as is seen in pyomyositis. The entity of pyomyositis is discussed in a separate chapter, Chapter 22, Deep Soft-Tissue Infections: Necrotizing Fasciitis and Gas Gangrene.
A variety of precipitating factors can lead to rhabdomyolysis. These include crush and compression injuries, drug and alcohol ingestion, metabolic and electrolyte disturbances, hypothermia and hyperthermia, and a variety of miscellaneous infections. This review focuses on infectious causes. It is important to distinguish rhabdomyolysis caused by a pathogen from that caused by sepsis, hypotension, or electrolyte imbalances that accompany a severe systemic infection.
VIRAL INFECTIONS
The wide spectrum of viral infections that have been reported to cause rhabdomyolysis are listed in Table 71.1. Influenza is the most common viral etiology reported to precipitate rhabdomyolysis, followed by human immunodeficiency virus (HIV) and enteroviral infection. The presenting symptoms in these patients include myalgias, weakness, muscle tenderness, and edema. Whether the association with influenza results primarily from a special predilection of the virus for the muscle tissue or frequent reporting of the association because of physician awareness and relative ease of diagnosis is unclear.
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