Etoposide-Associated Severe Rhabdomyolysis in a Patient with Diffuse Large B-Cell Lymphoma: A case report and review of the literature

TL;DR

A 62-year-old man developed severe muscle breakdown after etoposide chemotherapy for lymphoma, highlighting the rare but serious side effect of this treatment.

Contribution

This case report adds to the limited literature on etoposide-induced rhabdomyolysis and emphasizes early recognition for better outcomes.

Findings

Severe rhabdomyolysis occurred after the first cycle of R-CEOP chemotherapy in a lymphoma patient.

The patient developed acute kidney injury requiring dialysis but eventually recovered.

No infectious, inflammatory, or structural causes were identified, suggesting etoposide as the likely trigger.

Abstract

Rhabdomyolysis is a clinical syndrome characterised by skeletal muscle necrosis with subsequent release of intracellular constituents into the circulation. Although multifactorial in aetiology, chemotherapeutic agents, including etoposide, are rarely implicated. We report a 62-year-old male who presented to a tertiary care hospital in Muscat, Oman, in 2023 with severe rhabdomyolysis and advanced-stage diffuse large B-cell lymphoma following the first cycle of R-CEOP chemotherapy. Extensive evaluation excluded infectious, inflammatory and structural neuromuscular aetiologies. Work-up for metabolic myopathy suggested, but did not confirm, multiple acyl-CoA dehydrogenase deficiency. The patient's clinical course was complicated by acute kidney injury necessitating dialysis, followed by gradual renal and neuromuscular recovery. This report underscores the importance of maintaining clinical vigilance for rhabdomyolysis as a potential complication of etoposide-containing regimens, and the need for early recognition and supportive management.

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