H3N2 was first detected in July 2011 in the USA. It is responsible for sporadic cases of influenza and localised outbreaks and has not yet taken over on an epidemic or pandemic scale. An 84-year-old man presented with a dry cough, fever and myalgia for 3 days. On examination, he had a pulse of 98 bpm and blood pressure of 124/88 mm Hg. The patient was tachypnoeic, SpO2 was 90%. Auscultation revealed bilateral diffuse wheeze and crackles. He had generalised muscle tenderness on examination. On admission, creatinine was 1.9 mg/dL and CK(creatine kinase) was 44 000 U/L. Chest X-ray was suggestive of ARDS (acute respiratory distress syndrome). Throat swab was positive for H3N2. The patient was given intravenous fluids, oral sodium bicarbonate, oxygen and oseltamivir tablet. In view of ARDS, he was given intravenous methylprednisolone and bronchodilators for bronchospasm. The patient improved symptomatically; vitals and lab reports were normal at the time of discharge.

/pdf/a-case-of-h3n2-complicated-by-acute-kidney-injury-secondary-1gw42jtjzb.pdf

A case of H3N2 complicated by acute kidney injury secondary to rhabdomyolysis

Few publications of exercise-induced rhabomyolysis currently exist in the medical literature besides case reports. However, this condition can be severe, resulting in hospitalization and IV fluid administration to prevent serious sequelae. This report describes a case of exercise-induced rhabdomyolysis caused by a CrossFit workout. A 31-year-old female presented with 2 days of bilateral upper extremity pain and soreness, which began 2 days after she completed a CrossFit workout. Workup revealed an elevated creatine phosphokinase (CPK) of 18 441 U/L, consistent with exercise-induced rhabdomyolysis, and elevated liver function tests and elevated D-dimer, although her renal function was normal. She was hospitalized for 2 days and treated with IV fluids. This case report demonstrates that CrossFit exercises can lead to rhabdomyolysis, highlighting a condition that may be underdiagnosed and underreported.

Exertional and CrossFit-Induced Rhabdomyolysis

Rhabdomyolysis describes a clinical syndrome in which striated 			muscle breaks down and intracellular contents are released into the 			circulation. Exertional rhabdomyolysis can be caused by a new, 			intense workout routine or a change in intensity of an existing one. 			The severity of presentation varies from asymptomatic creatine 			kinase (CK) elevations to 			life-threatening renal failure, disseminated intravascular 			coagulation, cardiac dysrhythmias and/or compartment syndrome. Our 			case describes a patient with exertional non-traumatic 			rhabdomyolysis caused by a mild workout routine change with markedly 			elevated CK level. There was no evidence of any concomitant renal 			failure or other aberrancies, such as compartment syndrome, 			electrolyte abnormalities or electrocardiogram changes. Although the 			patient reports this as his initial episode of such symptoms, 			inherited metabolic disorders and genetic mutations should be 			considered and further workup performed. To the best of our 			knowledge, this is a rare case of a significantly elevated CK resulting from modest exercise that did not result in acute kidney 			injury. J Med Cases. 2014;5(9):483-485 doi: http://dx.doi.org/10.14740/jmc1792w

Exertional Rhabdomyolysis: A Case of Markedly Elevated Creatine Kinase Without Acute Kidney Injury

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Exertional Rhabdomyolysis: A Case of Markedly Elevated Creatine Kinase Without Acute Kidney Injury