You have probably never heard of rhabdomyolysis.
Children with rhabdomyolysis have severe muscle pain, muscle weakness, and dark urine.
It is classically caused by exercising too much (really overdoing it or exercising a lot more or a lot longer than you typically do) and damaging your muscles, leading to a breakdown of muscle cells and the release of creatine kinase, which in addition to muscle symptoms, can lead to kidney failure.
In addition to exercise, rhabdomyolysis can be caused by seizures, drugs, toxins, insect stings, snake bites, metabolic disorders, infections (viral myositis), and trauma.
“The most common causes of pediatric rhabdomyolysis were viral myositis (38%), trauma (26%), and connective tissue disease (5%).”
Mannix et al on Acute Pediatric Rhabdomyolysis: Causes and Rates of Renal Failure
Keep in mind that rhabdomyolysis is rare. You won’t confuse the aches and pains that most kids get, and which often get blamed on growing pains, with rhabdomyolysis. Although younger kids don’t always have dark urine when they have rhabdo, the pain and weakness is severe. Seek immediate medical attention if you think that your child might have rhabdomyolysis.
Can Vaccines Cause Rhabdomyolysis?
It is well known that rhabdomyolysis can be caused by infections.
“Rhabdomyolysis has been reported to be associated with a variety of viral infections, including influenza, [15,16] Coxsackie virus, human immunodeficiency virus (HIV), echovirus and cytomegalovirus [17]. In our series, the definite viral infection was identified in 5 patients (influenza type B in 4, Coxsackie A10 in 1)”
Chen et al on Clinical spectrum of rhabdomyolysis presented to pediatric emergency department
So if a natural influenza virus infection can cause rhabdomyolysis, does that mean that the flu vaccine can too? What about other vaccines?
Not necessarily, but there are a few case reports that associate vaccines with rhabdomyolysis.
“Influenza A infection has been described as a major viral cause of infection-induced rhabdomyolysis, but to date, only one reported case was described as having been induced by influenza vaccine.”
Callado et al on Rhabdomyolysis secondary to influenza A H1N1 vaccine resulting in acute kidney injury.
In several of the reports, patients already had chronic medical problems for which they were being treated. Still, no signal was found to suggest that the flu vaccine is a problem for these patients.
It is important to note that reports of post-vaccination rhabdomyolysis in healthy people are even rarer.
So while it is could be possible that vaccines are rarely associated with rhabdomyolysis, we know that many infections, including many vaccine-preventable diseases, are a more common cause.
Don’t skip or delay a vaccine because you might have heard that vaccines cause rhabdomyolysis.
Vaccines are safe, with few risks, and are obviously necessary.
More on Vaccines and Rhabdomyolysis
- Study – Acute Pediatric Rhabdomyolysis: Causes and Rates of Renal Failure
- Study – Clinical spectrum of rhabdomyolysis presented to pediatric emergency department
- Study – Factors associated with nontraumatic rhabdomyolysis and acute renal failure of children in Taiwan population.
- Study – Influenza B-associated rhabdomyolysis in Taiwanese children.
- Study – Severe rhabdomyolysis following a viral illness: a case report and review of the literature.
- Study – Rhabdomyolysis with different etiologies in childhood
- Study – Acute Pediatric Rhabdomyolysis: Causes and Rates of Renal Failure
- Study – Virus-associated Rhabdomyolysis in Children
- Study – Rhabdomyolysis Associated With 2009 Influenza A(H1N1)
- Study – Rhabdomyolysis in an Adolescent Associated With Parainfluenza Type 1 Virus
- Study – Rhabdomyolysis Complicating Typhoid Fever in a Child and Review of the Literature
- Study – Rhabdomyolysis in an Infant With Primary Human Herpesvirus 6 Infection
- Study – Severe rhabdomyolysis associated in meningococcemia.
- Study – Rhabdomyolysis in Scrub Typhus: An Unusual Presentation
- Rhabdomyolysis
- Study – Rhabdomyolysis probably induced by influenza vaccine and fibrate therapy
- Study – Influenza vaccine–a possible trigger of rhabdomyolysis induced acute renal failure due to the combined use of cerivastatin and bezafibrate.
- Study – Rhabdomyolysis with acute renal failure triggered by the seasonal flu vaccination in a patient taking simvastatin.
- Study – No signal of interactions between influenza vaccines and drugs used for chronic diseases: a case-by-case analysis of the vaccine adverse event reporting system and vigibase.
- Study – Influenza vaccine-induced rhabdomyolysis leading to acute renal transplant dysfunction.
- Study – Rhabdomyolysis secondary to tetanus toxoid administration in a patient following minor laceration.
- Study – Rhabdomyolysis secondary to influenza A H1N1 vaccine resulting in acute kidney injury.
- Study – Post-vaccination myositis and myocarditis in a previously healthy male.
Many years ago I vaccinated a child with Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency against the flu. Unfortunately he had had a mild cold at the time. He developed severe rhabdomyolysis shortly after the shot necessitating a few weeks of intensive care. I still do not know whether the cold or the shot was the cause, but I believe the shot played its part. Recently I wrote a chapter about vaccinating children with metabolic diseases in a textbook and again I realized how little we know about the topic.