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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.41 no.3 São Paulo Sept. 1983

http://dx.doi.org/10.1590/S0004-282X1983000300009 

Rabdomiolise e mioglobinuria: relato de caso agudo com boa evolução

 

Rhabdomyolysis and myoglobinuria: a case report

 

 

Osiris Esteves PintoI; Svetlana AgapejevII; João Antonio Maciel NóbregaIII

IProfessor Assistente. Departamento de Neurologia e Psiquiatria da Faculdade de Medicina, Campus de Botucatu, UNESP
IIProfessor Auxiliar de Ensino. Departamento de Neurologia e Psiquiatria da Faculdade de Medicina, Campus de Botucatu, UNESP
IIIProfessor Adjunto do Departamento de Neurologia e Neurocirurgia da Escola Paulista de Medicina

 

 


RESUMO

Os autores registram um caso de mioglobinúria confirmada pela eletroforese de proteínas da urina. A eletromiografia revelou alterações de tipo polimiosítico. A biópsia muscular do deltóide esquerdo mostrou processo inflamatório muscular inespecífico. O tratamento instituído baseou-se em repouso, hiperhidratação e alcalinização da urina. Os autores enfatizam a importância do diagnóstico pela relativa benignidade do processo, que tende para a cura se forem superadas as sérias complicações da fase aguda, a iatrogenia medicamentosa e por procedimentos diagnósticos desnecessários no início da doença.


SUMMARY

A case of paroxysmal myoglobinuric myopathy diagnosed by urinary protein electrophoresis is reported. Electromyograph (EMG) study done 20 days after onset of the symptoms demonstrated a polimyositic feature with normal motor and sensitive nervous conduction pattern. A biopsy of the left deltoid muscle performed 3 days after the EMG showed only an inespecific inflammation. The treatment included bed rest, parenteral fluids administration in excess (about 3,000 ml per day) and urinary alkalinization. Recovery started on the 2nd day of hospitalization when the patient showed progressive decrease in pain and weakness; furthermore the patient reacquired his mobility. The myoglobinuria start diminishing in intensity on the third day. The clinical picture of the patient continued to improve in the next 2 weeks, and slow recovery of the muscular strength occurred during the following two months of convalescence. In the present case we were not able to stablish the etiology of the illness. Nevertheless the clinical history suggests that infection, allergy and/or parenteral drug administration have had some role in precipitating the disease. This case report reinforces the concept that it is necessary an early and precise diagnosis of this syndrome followed by an adequate therapeutic approach avoiding the unnecessary use of drugs which "per se" could aggravate the disease.


 

 

Texto completo disponível apenas em PDF.

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REFERENCIAS

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3. GOLLNICK, P. D.; IANUZZO, C. D. & WILLIAMS, C. - Effect of prolonged severe exercise on the ultrastructure of human skeletal muscle. Int. Z. Angew Physiol. 27:257, 1969.         [ Links ]

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5. PENN, A. S.; ROWLAND, L. P. & FRASER, D. W. - Drugs, coma and myoglobinuria. Arch. Neurol. (Chicago) 26:336, 1972.         [ Links ]

6. PERKOFF, G. T. - Rhabdomyolisis: the Myoglobinurias. In Goldensohn, E. S. & Appel, S. H. (eds.) - Scientific Approaches to Clinical Neurology. Lea & Febiger, Philadelphia, 1977, pg. 1725.         [ Links ]

7. SHY, G. M. - Neuromuscular disorders: diseases of muscle. In Beeson & Mc Dermatt (eds.) - Textbook of Medicine. Saunders, Philadelphia, 1967, pg. 1670.         [ Links ]

8. SINGHAL, P. C: CHUGH, K. S. & GULATI, D. R. - Myoglobinuria and renal failure after status epilepticus. Neurol. (Minneapolis) 28:200, 1978.         [ Links ]

 

 

Nota dos autores - Agradecemos a colaboração do Prof. Wilson Nakamoto na realização do estudo eletroforético.
Departamento de Neurologia e Psiquiatria - Faculdade de Medicina - 18610 Rubião Junior - Botucatu, SP - Brasil.

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