NDT Advance Access originally published online on October 4, 2005
Nephrology Dialysis Transplantation 2006 21(1):233-234; doi:10.1093/ndt/gfi158
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Fever with acute renal failure due to body massage-induced rhabdomyolysis
Email: sdlee{at}vghtpe.gov.twSir,
Body massage, known as complementary and alternative medicine, is very popular in the world [1,2]. [It is considered a relatively safe therapy for the senior population that attempts to relieve pain or improve quality of life.] However, in one incident, an 88-year-old man developed rhabdomyolysis in the aftermath of a body massage session.
The gentleman was quite healthy in the past, with a history of type 2 diabetes mellitus under well-controlled by diet. He presented with a fall-down accident due to weakness of four limbs, fever (
38°C), acute renal failure (ARF) (creatinine 1.7 mg/dl, urea nitrogen 22 mg/dl) and mild proteinuria (initial urinalysis: protein ++, occult blood +++, WBC 5–10/HP, RBC 0–2/HP), but no significant ecchymosis or swelling of whole body were found. Though urinary tract infection was once suspected at a local hospital for his fever, leucocytosis (WBC 21.5 x 103/µl, neutrophils 89%) with mild pyuria, it was excluded by repeated urinalysis (protein 100 mg/dl, pH 5.0, WBC 0–2/HP, RBC 0–2/HP) and finally sterile cultures of urine and blood. His blood biochemistry showed as follows: aspartate aminotransferase 322 U/l, alanine aminotransferase 72 U/l, lactic dehydrogenase 1224 U/l, creatine phosphokinase (CPK) 7940 U/l with 100% of CPK-MM form, potassium 6.5 mEq/l, creatinine 1.2 mg/dl and urea nitrogen 19 mg/dl. After adequate hydration with intravenous fluid, solute alkaline diuresis and rapid-acting insulin, his serum potassium level normalized within 6 h and his fever subsided with regained strength 3 days later. The time–concentration curve of CPK was almost parallel to that of WBC of peripheral blood and serum C-reactive protein (CRP) level (Figure 1), indicating that the extent of inflammation was closely related to rhabdomyolysis process.
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An enquiry disclosed the habit of the patient: for more than 40 years, he had regularly received body massage for 1–2 h every other day. The afternoon before this accident, he received a body massage session for 2 h served by two new massagists at the same time instead of one. The strength of this massage session was significantly stronger than that of the past. He drank little water before and after the massage session. Generalized muscle pain and soreness developed that night but was not given attention.
Compression or pressure-induced rhabdomyolysis has been reported in coma or immobilized patients [3,4], prolonged cardiopulmonary resuscitation [5] and obese men who received bariatric surgery [6], but it has never been associated with body massage. Senior and diabetic patients need to be warned that vigorous body massage may cause dangerous complications such as rhabdomyolysis. In addition, the people receiving body massage should drink adequate amount of water before and after the massage session so as to prevent unusual episodes of rhabdomyolysis-associated ARF, which is exacerbated by volume depletion [3,4].
Conflict of interest statement. None declared.
1 Department of Medicine, Taipei Veterans General Hospital, and 2 National Yang-Ming, University School of Medicine, Taipei, Taiwan
References
- Eisenberg DM, Davis RB, Ettner SL et al. Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. J Am Med Assoc 1998; 280: 1569–1575
[Abstract/Free Full Text] - Suzuki N. Complementary and alternative medicine: a Japanese perspective. Evid Based Complement Alternat Med 2004; 1: 113–118
[Free Full Text] - Vanholder R, Sever MS, Erek E, Lameire N. Rhabdomyolysis. J Am Soc Nephrol 2000; 11: 1553–1561
[Free Full Text] - Sauret JM, Marinides G, Wang GK. Rhabdomyolysis. Am Fam Physician 2002; 65: 907–912[Web of Science][Medline]
- Hojs R, Sinkovic A, Hojs-Fabjan T. Rhabdomyolysis and acute renal failure following cardioversion and cardiopulmonary resuscitation. Renal Failure 1995; 17: 765–768[Medline]
- Torres-Villabobos G, Kimura E, Mosqueda JL, Garcia-Garcia E, Dominguez-Cherit G, Herrera MF. Pressure-induced rhabdomyolysis after bariatric surgery. Obesity Surgery 2003; 13: 297–301[Medline]
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