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Reversible myocardial calcification following severe leptospirosis complicated with rhabdomyolysis-induced acute kidney injury and magnesium-wasting nephropathy
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Authors
Advisor(s)
Abstract(s)
We present a patient with leptospirosis infection who presented septic
shock with multiple-organ dysfunction syndrome, severe rhabdomyolysis
and acute myocarditis. He developed biphasic blood
calcium pattern with hypocalcemia in the oliguric phase followed
by hypercalcemia during the recovery diuretic phase in the context
of rhabdomyolysis and oliguric acute kidney injury. Meanwhile,
he developed an extensive calcification of the myocardium. Severe
renal magnesium wasting was observed during the convalescence
phase. Follow-up showed progressive resorption and later almost
total disappearance of the calcific deposits in the heart by the 18th
month after discharge. Renal magnesium wasting decreased gradually,
but yet persisted beyond the 18th and was normalized only by
the 36th month after discharge. We discuss the pathophysiologic
mechanisms involved in the myocardial calcification and renal
magnesium wasting and suggest a possibility of a contributing role
of magnesium renal wasting in mobilization of calcium deposits out of myocardium
Description
Keywords
Leptospirosis Myocardial calcification Acute kidney injury Rhabdomyolysis Magnesium wasting nephropathy
Citation
J Med Cases. 2013;4(2):92-98