J Korean Med Sci.  2004 Dec;19(6):891-894. 10.3346/jkms.2004.19.6.891.

Hepatocellular Carcinoma, Polymyositis, Rhabdomyolysis, and Acute Renal Failure

• Kim MJ
• Kim JA
• Sung MS
• Min JK

• KMID: 1778575
• DOI: http://doi.org/10.3346/jkms.2004.19.6.891

Abstract

A 55 yr-old man presented with progressive muscle weakness and oliguria for 5days. Laboratory findings suggested rhabdomyolysis complicated with acute renal failure. A diagnosis of polymyositis was based upon the proximal muscle weakness on both upper and lower limbs, elevated muscle enzyme levels, muscle biopsy findings and the needle electromyography findings. The muscle biopsy showed extensive muscle necrosis and calcification. Investigations for underlying malignancy demonstrated hepatocellular carcinoma. The patient was managed with hemodialysis and high dose prednisolone. His renal function was fully recovered and his muscle power did improve slightly, but he died of a rupture of the hepatic tumor. In our view, this is an interesting case in that the hepatocellular carcinoma was associated with polymyositis and fulminant rhabdomyolysis-induced acute renal failure requiring hemodialysis.

Keyword

Carcinoma, Hepatocellular; Polymyositis; Rhabdomyolysis; Kidney Failure, Acute

MeSH Terms

Carcinoma, Hepatocellular/complications/*diagnosis
Diagnosis, Differential
Humans
Kidney Failure, Acute/*diagnosis/etiology
Liver Neoplasms/complications/*diagnosis
Male
Middle Aged
Polymyositis/complications/*diagnosis
Rhabdomyolysis/*diagnosis/etiology

Figure

• 

  Fig. 1 The histologic findings of liver showing hepatocellular carcinoma (H&E, ×200).

• 

  Fig. 2 The histologic findings of skeletal muscle showing muscle necrosis with calcification (arrow head) (H&E, ×400).

Reference

1. Yazici Y, Kagen LJ. The association of malignancy with myositis. Curr Opin Rheumatol. 2000. 12:498–500.

2. Zantos D, Zhang Y, Felson D. The overall and temporal association of cancer with polymyositis and dermatomyositis. J Rheumatol. 1994. 21:1855–1859.

3. Hasegawa K, Uesugi H, Kubota K, Ugawa Y, Murayama S, Kobayashi T, Hippo Y, Gunji T, Ohnishi S, Mori M, Makuuchi M. Polymyositis as a paraneoplastic manifestation of hepatocellular carcinoma. Hepatogastroenterology. 2000. 47:1425–1427.

4. Leaute-Labreze C, Perel Y, Taieb A. Childhood dermatomyositis associated with hepatocarcinoma. N Engl J Med. 1995. 333:1083.

5. Horie Y, Yamada M, Nakai K, Kawasaki H, Hirayama C, Matsui K, Kambe N, Shimao S. Combined hepatocellular-cholangiocarcinoma associated with dermatomyositis. J Gastroenterol Hepatol. 1989. 4:101–104.

6. Sattar MA, Guindi RT, Khan RA, Tungekar MF. Polymyositis and hepatocellular carcinoma. Clin Rheumatol. 1988. 7:538–542.

7. Yum JH, Jung YK, Kim YH, Ahn BJ, Son JH, Jeon YD, Chung SO. A case of acute renal failure due to rhabdomyolysis associated with dermatomyositis in breast cancer. Korean J Nephrol. 1999. 18:334–338.

8. Lewington AJ, D'Souza R, Carr S, O'Reilly K, Warwick GL. Polymyositis: a cause of acute renal failure. Nephrol Dial Transplant. 1996. 11:699–701.

9. Thakur V, DeSalvo J, McGrath H Jr, Weed S, Garcia C. Case report: Polymyositis-induced myoglobinuric acute renal failure. Am J Med Sci. 1996. 312:85–87.

10. Caccamo DV, Keene CY, Durham J, Peven D. Fulminant rhabdomyolysis in a patient with dermatomyositis. Neurology. 1993. 43:844–845.

11. Weidensaul D, Imam T, Holyst MM, King PD, McMurry RW. Polymyositis, pulmonary fibrosis, and hepatitis C. Arthritis Rheum. 1995. 38:437–439.

12. Gomez A, Solans R, Simeon CP, Selva A, Garcia F, Fonollosa V, Vilardell M. Dermatomyositis, hepatocarcinoma, and hepatitis C: comment on the article by Weidensaul et al. Arthritis Rheum. 1997. 40:394–395.

13. Hadjis T, Grieff M, Lockhat D, Kaye M. Calcium metabolism in acute renal failure due to rhabdomyolysis. Clin Nephrol. 1993. 39:22–27.

14. Coakley JH, Smith PE, Jackson MJ, Edwards RH, Carty AT. Myositis ossificans non-progressiva-reversible muscle calcification in polymyositis. Br J Rheumatol. 1989. 28:443–445.

15. Gray RE. The mechanism of muscle calcification. Br J Rheumatol. 1990. 29:155–156.

16. Adams EM, Chow CK, Premkumar A, Plotz PH. The idiopathic inflammatory myopathies: spectrum of MR imaging findings. Radiographics. 1995. 15:563–574.

17. Akmal M, Goldstein DA, Telfer N, Wilkinson E, Massry SG. Resolution of muscle calcification in rhabdomyolysis and acute renal failure. Ann Intern Med. 1978. 89:928–930.