Ann Rehabil Med.  2015 Oct;39(5):826-832. 10.5535/arm.2015.39.5.826.

Hypokalemia-Induced Rhabdomyolysis by Primary Aldosteronism Coexistent With Sporadic Inclusion Body Myositis

• Lee JH
• Kim E
• Chon S

• KMID: 2148215
• DOI: http://doi.org/10.5535/arm.2015.39.5.826

Abstract

We describes a patient with hypokalemia-induced rhabdomyolysis due to primary aldosteronism (PA), who suffered from slowly progressive muscle weakness after laparoscopic adrenalectomy, and was later diagnosed with coexisting sporadic inclusion body myositis (sIBM). A 54-year-old Asian male presented with severe muscle weakness of both lower extremities. Laboratory findings showed profound hypokalemia, and extreme elevation of the serum creatine phosphokinase levels, suggestive of hypokalemia-induced rhabdomyolysis. Further evaluation strongly suggested PA by an aldosterone-producing adenoma, which was successfully removed surgically. However, muscle weakness slowly progressed one year after the operation and a muscle biopsy demonstrated findings consistent with sIBM. This case is the first report of hypokalemia-induced rhabdomyolysis by PA coexistent with sIBM, to the best of our knowledge.

Keyword

Rhabdomyolysis; Aldosteronism; Hypokalemia; Inclusion body myositis

MeSH Terms

Adenoma
Adrenalectomy
Asian Continental Ancestry Group
Biopsy
Creatine Kinase
Humans
Hyperaldosteronism*
Hypokalemia
Lower Extremity
Male
Middle Aged
Muscle Weakness
Myositis, Inclusion Body*
Rhabdomyolysis*
Creatine Kinase

Figure

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  Fig. 1 Magnetic resonance imaging findings of the (A) cervical and (B) lumbar spines. Central and left paracentral and inferior disc extrusion at L5-S1, ossification of the posterior longitudinal ligament at C5-6 and central and left paracentral disc protrusion at C5-6 and C6-7 were shown.

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  Fig. 2 (A) Adrenal computed tomography shows a 1.5×1-cm-sized ovoid mass at the body of the right adrenal gland. (B, C) Microscopic findings of the resected right adrenal gland. Sections disclose portions of adrenal cortical adenoma showing a well circumscribed tumor tissue consisting of proliferation of some zona glomerulosa and mostly fasciculata-resembling cells (H&E, B 100×, C 400×).

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  Fig. 3 (A) Light microscopy of the biopsy specimen from the left vastus lateralis shows marked size variation of myofibers; some rimmed vacuoles with basophilic stippling; round atrophic and degenerating myofibers; endomysial fibrosis and fatty change (H&E 400×). (B) Electron microscopy shows size variation of myofibers with rarefaction of myofilaments; many myelin figure-like concentric lamellated membranous bodies and degenerated organelles in subsarcolemmal and intermyofibrillar areas (electron microscope 6000×), consistent with inclusion body myositis.

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