A case of rhabdomyolysis as a complication of gemcitabine chemotherapy for biliary cancer

Abstract

A 69-year-old woman diagnosed with biliary cancer was admitted to our hospital. Because she was diagnosed with liver metastases, we started to treat her with gemcitabine as an outpatient. After 148 days of administration, she felt slight muscle weakness in bilateral proximal lower extremity. Subsequently, her muscular signs and symptoms progressed. At 162 days of administration, she was admitted because of muscle pain and muscle weakness in her bilateral proximal lower extremity, pyrexia and oliguria. Investigation revealed increased serum levels of creatine kinase (2565 IU/l), lactate dehydrogenase, aspartate aminotransferase, white blood cell count and C-reactive protein. Although she showed acute renal failure, it immediately improved with hydration, and the creatine kinase level returned to normal range after 5 days. The syndrome gradually improved after the discontinuation of chemotherapy and bed rest with hospitalization. The diagnosis of gemcitabine-induced rhabdomyolysis was supported after the exclusion of other possible diagnoses.