Advertisement

International Journal of Legal Medicine

, Volume 126, Issue 6, pp 953–956 | Cite as

Severe generalised rhabdomyolysis with fatal outcome associated with isotretinoin

  • Benno Hartung
  • Hans F. Merk
  • Wolfgang Huckenbeck
  • Thomas Daldrup
  • Eva Neuen-Jacob
  • Stefanie Ritz-Timme
Case Report

Abstract

Isotretinoin is considered to be a safe and effective therapy in otherwise therapy-resistant acne. Elevated serum creatine phosphokinase values with or without muscle-related symptoms in isotretinoin-treated patients have been reported and interpreted as benign phenomena, lethal cases have not been described yet. We present the case of a 20-year-old male who died from severe generalised rhabdomyolysis associated with isotretinoin treatment.

Keywords

Isotretinoin Adverse drug reaction Muscle pain Rhabdomyolysis Myocytolysis 

References

  1. 1.
    Goulden V, Clark SM, McGeown C, Cunliffe WJ (1997) Treatment of acne with intermittent isotretinoin. Br J Dermatol 137:106–108PubMedCrossRefGoogle Scholar
  2. 2.
    Shalita AR, Cunningham WJ, Leyden JJ, Pochi PE, Strauss JS (1983) Isotretinoin treatment of acne and related disorders: an update. J Am Acad Dermatol 9:629–638PubMedCrossRefGoogle Scholar
  3. 3.
    Layton AM, Knaggs H, Taylor J, Cunliffe WJ (1993) Isotretinoin for acne vulgaris—10 years later: a safe and successful treatment. Br J Dermatol 129:292–296PubMedCrossRefGoogle Scholar
  4. 4.
    Bershad S, Rubinstein A, Paterniti JR, Le NA, Poliak SC, Heller B, Ginsberg HN, Fleischmajer R, Brown WV (1985) Changes in plasma lipids and lipoproteins during isotretinoin therapy for acne. N Engl J Med 313:981–985PubMedCrossRefGoogle Scholar
  5. 5.
    Dootson GM, Keidan J, Harper PL (1995) The influence of isotretinoin upon fibrinolysis in patients with acne. Br J Dermatol 133:66–70PubMedCrossRefGoogle Scholar
  6. 6.
    Rote Liste (2010) Arzneimittelverzeichnis für Deutschland. Rote Liste Service GmbH, FrankfurtGoogle Scholar
  7. 7.
    Arzneimittelkommission der deutschen Ärzteschaft (2012) Aus der UAW-Datenbank. Isotretinoin und chronisch-entzündliche Darmerkrankung. Dtsch Ärztebl 109:A-1044/ B-900/ C-892Google Scholar
  8. 8.
    McBurney EI, Rosen DA (1984) Elevated creatine phosphokinase with isotretinoin. J Am Acad Dermatol 10:528–529PubMedCrossRefGoogle Scholar
  9. 9.
    Hodak E, Gadoth N, David M, Sandbank M (1986) Muscle damage induced by isotretinoin. Br Med J 293:425–426CrossRefGoogle Scholar
  10. 10.
    Guttmann-Yassky E, Hayek T, Muchnik L, Bergman R (2003) Acute rhabdomyolsis and myoglobinuria associated with isotretinoin treatment. Int J Derm 42:499–500CrossRefGoogle Scholar
  11. 11.
    Gomez-Bernal S, Rodriguez-Pazos L, Rodriguez-Granados MT, Toribio J (2011) Rhabdomyolysis during isotretinoin therapy. Actas Dermosifiliogr 102:390–391PubMedCrossRefGoogle Scholar
  12. 12.
    Trauner MA, Ruben BS (1999) Isotretinoin induced rhabdomyolysis? A case report. Dermatol Online J 5:2PubMedGoogle Scholar
  13. 13.
    Heudes AM, Laroche L (1998) Muscular damage during isotretinoin treatment. Ann Dermatol Venereol 125:94–97PubMedGoogle Scholar
  14. 14.
    Landau M, Mesterman R, Ophir J, Mevorah B, Alcalay J, Harel A, Nevo Y (2001) Clinical significance of markedly elevated serum creatine kinase levels in patients with acne on isotretinoin. Acta Derm Venereol 81:350–352PubMedCrossRefGoogle Scholar
  15. 15.
    Kaymak Y (2008) Creatine phosphokinase values during isotretinoin treatment for acne. Int J Derm 47:398–401PubMedCrossRefGoogle Scholar
  16. 16.
    Brinkmann B (1999) Harmonisation of medico-legal autopsy rules. Committee of Ministers. Council of Europe. Int J Leg Med 113:1–14CrossRefGoogle Scholar
  17. 17.
    Ferrara SD, Bajanowski T, Cecchi R, Snenghi R, Case C, Viel G (2010) Bio-medical guidelines and protocols: survey and future perspectives in Europe. Int J Leg Med 124:345–350CrossRefGoogle Scholar
  18. 18.
    Fracasso T, Karger B, Pfeiffer H, Sauerland C, Schmeling A (2010) Immunohistochemical identification of prevalent right ventricular ischemia causing right heart failure in cases of pulmonary fat embolism. Int J Legal Med 124:537–542PubMedCrossRefGoogle Scholar
  19. 19.
    Hartung B, Schott M, Daldrup T, Ritz-Timme S (2010) Lethal thyroid storm after uncontrolled intake of liothyronine in order to lose weight. Int J Legal Med 124:637–640PubMedCrossRefGoogle Scholar
  20. 20.
    Cecchi R, Cipollini L, Sestili C, Aromatario M, Ciallella C (2011) Pulmonary embolisation of bone fragments from penetrating cranial gunshot wounds. Int J Legal Med. doi: 10.1007/s00414-011-0643-9
  21. 21.
    Fracasso T, Schmeling A (2009) Delayed asphyxia due to inhalation injury. Int J Legal Med 125:289–292CrossRefGoogle Scholar
  22. 22.
    Huerta-Alardin AL, Varon J, Marik PE (2005) Bench-to-bedside review: rhabdomyolysis—an overview for clinicians. Crit Care 9:158–169PubMedCrossRefGoogle Scholar
  23. 23.
    Fachinformation Minocyclin-CT 50 mg Kapseln (2012) http://www.fachinfo.de/data/fi/jsearch?praep. Accessed 18 July 2012
  24. 24.
    Chroni E, Monastirli A, Tsambaos D (2010) Neuromuscular adverse effects associated with systemic retinoid dermatotherapy. Drug Saf 33:25–34PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Benno Hartung
    • 1
  • Hans F. Merk
    • 2
  • Wolfgang Huckenbeck
    • 1
  • Thomas Daldrup
    • 1
  • Eva Neuen-Jacob
    • 1
  • Stefanie Ritz-Timme
    • 1
  1. 1.University Hospital DuesseldorfDuesseldorfGermany
  2. 2.University Hospital AachenAachenGermany

Personalised recommendations