Endocrine Abstracts

Introduction: Fibrates are widely used to manage dyslipidemia but these drugs can induce rhabdomyolysis with acute renal failure. Rhabdomyolysis is a skeletal muscle cell damage condition associated with the release of toxic components of the cells and to the end;renal failure. The onset of rhabdomyolisis can extend to 6 months with fibrate therapy. Some researchers purpose that the influenza vaccıne can induce the rhabdomyolisis in patients who receive myotoxic drugs.Here we present a case who develops rhabdomyolisis and acute renal failure after influenza vaccine during fibrate therapy.

Case: A 65-year-old male patient admitted to the hospital with weakness and pain of the extremity muscles. He had tenderness widespread of the body and feel difficulty to move. He had coronary heart disease and hyperlipidemia. He was taking 267 mg of fenofibrate daily for 5 months and had influenza vaccine administration a week before admission to the hospital. Laboratory examination showed markedly elevated serum creatine kinase levels (27 730 U/l) and creatinine was 2.16 mg/dl (creatinine level was normal range before the vaccine administration). After discontinuing the fibrate therapy and adequate fluid resuscitation renal function recovered and the symptoms of myopathy resolved.

Conclusion: The risk of rhabdomyolysis increases with polypharmacy with myotoxic agents like lipid lowering medications. Also influenza vaccination administration must keep in mind an another myotoxic situation especially during lipid lowering drugs like fenofibrate.