# Rapid Aggravation of Rhabdomyolysis Caused by Daptomycin After Aortic Arch Replacement: A Case Report

## TL;DR

A patient developed severe rhabdomyolysis after a heart surgery, which worsened when given daptomycin for an infection.

## Contribution

This case report highlights daptomycin as a potential cause of rhabdomyolysis aggravation in post-surgical patients.

## Key findings

- Rhabdomyolysis worsened after daptomycin administration despite no new limb ischemia.
- CK levels peaked at 26,123 U/L after daptomycin use and normalized after discontinuation.
- Daptomycin should be used cautiously in patients recovering from rhabdomyolysis.

## Abstract

Although rare, rhabdomyolysis is a serious complication of cardiothoracic surgery. Daptomycin is a polypeptide antimicrobial agent used to treat methicillin-resistant Staphylococcus aureus (MRSA) infections of the soft tissues. Daptomycin is associated with elevations in serum creatine kinase (CK).

A 50-year-old man with acute Stanford A-type aortic dissection was performed Bentall procedure and total arch replacement with frozen elephant trunk. The CK level was 6,573 U/L on the first postoperative day (POD), suggesting rhabdomyolysis associated with lower limb ischemia. The CK level increased to 11,934 U/L on POD 2 and started to decrease thereafter. On POD 5, the patient had a suspected surgical site infection. Antibiotics were changed to empiric therapy of daptomycin and meropenem to address soft tissue MRSA infection. The CK level at the start of daptomycin administration was 4,122 U/L. However, the CK level rose to 21,813 U/L on POD 6. None of the findings suggested new-onset lower limb ischemia. Assuming that the rhabdomyolysis was induced by daptomycin, it was discontinued. The CK level peaked at 26,123 U/L on POD 8, after which it started to decrease and normalized on POD 16.

Daptomycin should be used with extreme caution in patients recovering from rhabdomyolysis.