Rhabdomyolysis associated with pneumococcal pneumonia: an early clinical indicator of increased morbidity?

Rhabdomyolysis most commonly results from crushing injuries, the toxic effects of drugs and alcohol, seizures, and strenuous physical activity. Though rhabdomyolysis has been rarely identified with bacterial pneumonia, it has recently been recognized that in the setting of Legionella pneumophila pneumonia it has important prognostic implications. In the English literature, there are 12 well-documented cases of rhabdomyolysis associated with Streptococcus pneumoniae pneumonia. Interestingly, in the majority of these patients, including ours, S. pneumoniae grew from their blood. Bacteremia in patients with S. pneumonia doubles the death rate. Nine of the 12 patients, ours included, with S. pneumoniae pneumonia associated rhabdomyolysis developed renal dysfunction, as evidenced by an elevation in their blood urea nitrogen (BUN) and serum creatinine. Uremia also indicates a poor prognosis in patients with pneumococcal pneumonia. Serum creatinine phosphokinase (CPK) is a simple test that may allow early recognition of S. pneumoniae pneumonia in patients who are at an increased risk for a poor outcome, and permit timely therapeutic intervention.