 Article
|
|
|
|
Services
|
|
|
|
Google Scholar
|
|
|
|
PubMed
|
|
|
|
LETTER
Tumor Necrosis Factor and Coxsackie B4 Rhabdomyolysis
Robert J. Konrad;
David B. P. Goodman; and
Walter L. Davis
15 October 1993 | Volume 119 Issue 8 | Pages 861-862
TO THE EDITOR:
A 23-year-old man presented with sore throat, diffuse muscle pain and weakness, enlarged tonsils, cervical lymphadenopathy, and myoglobinuria. His leukocyte count was 14.6 x 109/L; his lactate dehydrogenase concentration was 8200 U/L; his aspartate aminotransferase level was 2601 U/L; and his creatine kinase concentration was 650 000 U/L. Only twice previously have higher creatine kinase elevations been reported in virus-associated rhabdomyolysis [1, 2].
The patient was hydrated vigorously and was given indomethacin for pain relief; his creatine kinase concentration was 46 000 U/L at discharge 5 days after admission. Despite the severity of the rhabdomyolysis, the patient recovered completely, and his serum enzyme levels returned to normal 3 weeks later.
Antibody titers to the following viruses were examined: influenza viruses A and B; Coxsackie viruses B1, B2, B3, B4, B5, and B6; echovirus (types 4, 9, 11, and 30); and adenovirus. Convalescent-phase serum showed an eightfold increase in antibody titer to Coxsackie B4 virus compared with acute-phase serum (titer, 1:128 compared with 1:16).
As shown in Table 1, skeletal muscle breakdown, measured by superoxide release in a well-characterized animal model—Solenopsis species (red imported fire ant) [3, 4]—was increased by the patient's acute-phase serum (100 µL) or the cytokine tumor necrosis factor-
(TNF-) (minimum amount, 40 pg/mL). No TNF- was detectable in convalescent-phase and control sera (Cistron TNF- enzyme-linked immunosorbent assay). The patient's acute-phase serum contained 22 ± 3 pg/mL TNF-.
In our patient, acute-phase serum contained an elevated level of TNF- and induced skeletal muscle breakdown and increased superoxide production in vitro in a fashion similar to that caused by TNF-. As with TNF-, this myolysis was specifically blocked by anti-TNF- antibody.
1. Tanaka T, Takada T, Takagi D, Takeyama N, Kitazawa Y. Acute renal failure due to rhabdomyolysis associated with Echovirus 9 infection: a case report and review of literature. Jpn J Med. 1989; 28:237-42.
2. Fukuyama Y, Ando T, Yokata J. Acute fulminant myoglobinuric polymyositis with picornavirus-like crystals. J Neurol Neurosurg Psychiatr. 1977; 40:775-7.
3. Davis WL, Jones RG, Farmer GR. Insect hemolymph factor promotes histolysis in Solenopsis. Anat Record. 1989; 224:473-8.
4. Babior BR, Kipnes ZR, Curnutte J. Biological defense mechanisms. The production by leukocytes of superoxide, a potential bacteriocidal agent. J Clin Invest. 1973; 52:741-9.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
|
Article
|
|
|
|
Services
|
|
|
|
Google Scholar
|
|
|
|
PubMed
|
|
|
|
Top
References
