SEVERE HEMOLYSIS IN HAFF DISEASE ASSOCIATED WITH AFTER FISH CONSUMPTION? OLD MAN - CASE STUDY

Abstract

Objectives: The disease rhabdomyolysis is a condition without a defined direct cause, characterized by the rupture of muscle fibers and their release into the bloodstream of the intracellular constituents, causing myalgia and weakness in the patient, with severe pain mainly in the lower limbs and acute renal failure. Objective: To describe a case of death from Rhabdomyolysis disease after eating fish in the municipality of Itacoatiara, Amazonas, Brazil. Material e methods: Analysis of patient medical record containing your medical, clinical, laboratory and demographic data. Case related: An 89-year-old man with a fixed residence in the municipality of Novo Remanso, state of Amazonas, Brazil, reported symptoms of myalgia and dark urine 10 hours after consuming local fish, tambaqui (Colossoma macropomum) and pacu (Piaractus mesopotamicus). He was treated at the outpatient clinic of the Hospital José Mendes, municipality of the Itacoatiara, Amazonas state, Brazil on January 11, 2021, presenting with limited mobility, disorientation pain throughout his body. The patient was hospitalized with suspected Rhabdomyolysis, presenting blood pressure 130/80 with 94% Saturation and Temperature of 36.8°C. Laboratory tests showed CK levels of 4256.3 U/L. The hemogram showed moderate anemia with Erythrocytes: 3.27 M/mm3; Hemoglobin: 10.6 g/dL and Hematocrit: 29.1%. A treatment protocol for Rhabdomyolysis was immediately started, consisting of 500 mL of 0.9% saline solution, 20mg furosemide and 2 g Ceftriaxone, intravenously every 12 hours, for 7 days. After 48 hours, his blood count worsened with red blood cells: 2.94 M/mm3, Hemoglobin: 9.2 g/dL, Hematocrit: 25.2%, however, his serum CK levels decreased (887.4 U/L). Two packets of red blood cell concentrates and intravenous tramadol 100mg were transfused every 8 hours for seven days, and he was discharged on January 17, 2021, dying two later at his residence. Discussion: The state of Amazonas, Brasil, experienced an outbreak of Rhabdomyolysis between September 2021 to January 2023, with compulsory notifications and 103 cases confirmed, being 67 (65%) of them occurring only Itacoatiara municipality. Although the direct etiology for rhabdomyolysis is unknown, studies show that serum CK concentrations above 1000 U/l, combined with severe myalgia and myoglobinuria, have a high risk of developing rhabdomyolysis. Conclusion: In this way, we believe that the implementation of new therapeutic, clinical and laboratory approaches are necessary to assist in the early diagnosis of the disease and prevent clinical severity, particularly acute renal failure.