A previously healthy 22-year-old male developed severe with a serum creatine kinase (CK) of >100,000 U/L after taking terbinafine for 9 days.
Terbinafine use is associated with the potential onset of rhabdomyolysis, which can lead to severe muscle injury.
The patient experienced nausea, vomiting, and dark urine, symptoms indicative of rhabdomyolysis.
occurred alongside rhabdomyolysis, necessitating hemodialysis for management.
Immediate discontinuation of terbinafine and initiation of intravenous fluids and dialysis were critical in the patient's recovery.
Post-treatment, the patient's kidney function returned to baseline after 1 month of outpatient hemodialysis.
Simplified
RATIONALE: Terbinafine is an antimicrobial agent commonly prescribed for fungal infections. Its side effect profile is generally benign, but there is limited evidence that it has the potential to cause . Rhabdomyolysis is a potentially life-threatening condition caused by profound muscle injury. It has characteristic findings of muscle pain, weakness, and dark urine. When recognized early, patients with rhabdomyolysis can be managed conservatively with hydration and watchful monitoring. However, if treatments are delayed, or in severe cases of rhabdomyolysis, complications such as electrolyte abnormalities, , and disseminated intravascular coagulation can develop.
PRESENTING CONCERNS OF THE PATIENT: A previously healthy 22-year-old male presented with nausea, vomiting, and dark urine after taking terbinafine 250 mg daily for a tinea infection for 9 days. He developed severe rhabdomyolysis with a serum creatine kinase (CK) of >100 000 U/L as well as anuric acute kidney injury.
DIAGNOSIS: The clinical history combined with the diagnostic findings suggest acute kidney injury and rhabdomyolysis associated with terbinafine use.
INTERVENTIONS: Terbinafine use was stopped immediately. The patient was started on intravenous fluids and bicarbonate drip. Hemodialysis was initiated to prevent further complications. After his CK level decreased and his clinical status stabilized, he was discharged home and continued to receive outpatient hemodialysis treatments.
OUTCOME: The patient's kidney function returned to baseline after 1 month of outpatient hemodialysis treatments.
NOVEL FINDING: In this report, we present a case of rhabdomyolysis associated with terbinafine use that progressed to acute kidney injury requiring dialysis. Our case highlights a less known and severe side effect of this medication and emphasizes the importance of early recognition and treatment of rhabdomyolysis.
Key numbers
>100000 U/L
Creatine Kinase Level
Measured after 9 days of terbinafine use.
514 µmol/L
Serum Creatinine Level
Initial measurement upon emergency presentation.
1 month
Recovery Time
Time taken for kidney function recovery post-treatment.
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Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
