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Rhabdomyolysis associated with initiation of febuxostat therapy for hyperuricaemia in a patient with chronic kidney disease

Authors

  • Y. Kang MD,

    1. Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
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  • M. J. Kim MD,

    1. Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
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  • H. N. Jang MD,

    1. Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
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  • E. J. Bae MD,

    1. Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
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  • S. Yun MD,

    1. Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
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  • H. S. Cho MD,

    1. Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
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  • S.-H. Chang MD,

    1. Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
    2. Institute of Health Science, Gyeongsang National University Hospital, Jinju, South Korea
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  • D. J. Park MD

    Corresponding author
    1. Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
    2. Institute of Health Science, Gyeongsang National University Hospital, Jinju, South Korea
    • Correspondence: Dong Jun Park, MD, Department of Internal MedicineSchool of Medicine Gyeongsang University, 816 Beongil 15 Jinju-daero, Jinju, Gyeongnam, South Korea. Tel.: 055-750-8739; fax: 055-758-9122; e-mail: drpdj@korea.com

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Summary

What is known and objective

Febuxostat is now recommended as the first-line pharmacological urate-lowering therapy for gout in the American College of Rheumatology guidelines. There is no case of rhabdomyolysis associated with febuxostat among reported side effects of the drug. Our objective is to report on a case of rhabdomyolysis associated with initiation of febuxostat in a patient with chronic kidney disease (CKD).

Case summary

A 73-year-old male patient visited our emergency room due to progressive weakness in both lower extremities starting 3 days earlier. Ten days before presentation, his primary physician had changed his prescription from allopurinol to febuxostat (80 mg) because of poor control of uric acid levels. There was tenderness in both thighs. Initial creatinine kinase (CK) was 7652 U/L (0–170 U/L), and a bone scan using 99mTc-HDP revealed strong uptake in soft tissues in both thighs and buttocks. Electromyography (EMG) and nerve conduction velocity (NCV) showed abnormal spontaneous activities (ASA), suggesting myopathy, not nerve damage. On day 7 of admission, after conservative management and febuxostat withdrawal, he could walk on the ward. He is being followed in our clinic as an outpatient with no sequelae.

What is new and conclusion

This report is first case of rhabdomyolysis associated with initiation of febuxostat. Febuxostat should be withdrawn when rhabdomyolysis is confirmed.

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