Continuous Renal Replacement Therapy in a 4-year-old Child with Rhabdomyolysis Following Parainfluenza Virus Infection and Hyperammonemia due to Isovaleric Acidemia

Park, Se Jin; Cho, Soo Yeon; Pai, Ki Soo; Shin, Jae Il

doi:2013.17.2.132

J Korean Soc Pediatr Nephrol > Volume 17(2); 2013 > Article

Case Report

J Korean Soc Pediatr Nephrol 2013;17(2): 132-136. doi: https://doi.org/10.3339/jkspn.2013.17.2.132

Parainfluenza virus 감염 후 발생한 횡문근융해증과 isovaleric acidemia로 인한 고암모니아혈증을 가진 소 아에서의 지속적 신대체요법

박세진, 조수연, 배기수, 신재일

¹아주대학교 의과대학 소아청소년과학교실, 아주대병원 소아청소년과
²연세대학교 의과대학 소아과학교실, 세브란스 어린이병원 소아청소년과*

Continuous Renal Replacement Therapy in a 4-year-old Child with Rhabdomyolysis Following Parainfluenza Virus Infection and Hyperammonemia due to Isovaleric Acidemia

Se Jin Park, Soo Yeon Cho, Ki Soo Pai, Jae Il Shin

¹Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
²Department of Pediatrics*, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea

Corresponding Author: Jae Il Shin ,Tel: 02-2228-2050, Fax: 02-393-9118, Email: shinji@yuhs.ac

Received: September 14, 2013; Accepted: October 2, 2013.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons. org/licenses/bync/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Parainfluenza virus infection is one of the causes of fatal rhabdomyolysis. Rhabdomyolysis can be aggravated by mitochondrial fatty acid β-oxidation disorders during prolonged periods of fasting. Moreover, in patients with late-onset isovaleric acidemia, hyperammonemia may occur following catabolic stress. In the present report, we describe a case of a 4-year-old boy with parainfluenza virus infection and late-onset isovaleric acidemia that rapidly progressed to coma, seizures, and cardiorespiratory collapse. His serum ammonia and creatinine kinase (CK) levels were 385 μMol/L and 23,707 IU/L, respectively. Continuous renal replacement therapy (CRRT) was initiated using continuous venovenous hemodiafiltration, after which the ammonia and CK levels returned to normal. Thus, we recommend the immediate initiation of CRRT in the management of patients with life-threatening rhabdomyolysis and hyperammonemia.

Key words: Rhabdomyolysis | Hyperammonemia | Parainfluenza virus | Isovaleric acidemia | Continuous renal replacement therapy