Rhabdomyolysis following influenza A infection in children: case report and literature review

Influenza A infection is commonly associated with respiratory illness, ranging from mild upper respiratory infection to severe pneumonia and acute respiratory distress syndrome. Rhabdomyolysis is an uncommon but potentially fatal extrapulmonary complication of influenza A infection. Here, we report a rare case of rhabdomyolysis in a pediatric patient with influenza A infection. An 11-year-old girl had a tight cough and severe myalgia. It was noted she had contact with a classmate suffering from influenza-like syndrome. A rapid antigen test for influenza A was positive. Laboratory data showed a remarkably high level of creatine kinase (CK) level at 2,866 U/L. Based on these examinations, the girl was diagnosed with rhabdomyolysis as a complication from the influenza A infection. With treatment of aggressive hydration, her conditions improved steadily, and renal function remained normal throughout the entire disease course. The patient had no residual weakness or myalgia, and laboratory tests of CK and aspartate aminotransferase (AST) values returned to normal 3 and 11 days after discharge, respectively. As pediatric physicians, it should be noted that rhabdomyolysis maybe a complication of influenza A infection in pediatric patients with severe myalgia or muscle weakness, and appropriate treatment addressing rhabdomyolysis may reduce the risk of renal failure. Also, it is important to check the CK levels in hospitalized patients with influenza infection.