# Case Report: Sorafenib-induced rhabdomyolysis in a post-transplant patient with acute myeloid leukemia

## TL;DR

A patient with acute myeloid leukemia developed severe muscle damage (rhabdomyolysis) after taking sorafenib, a drug used to prevent cancer relapse.

## Contribution

This case report identifies sorafenib as a rare but serious cause of rhabdomyolysis in post-transplant patients.

## Key findings

- A 31-year-old female developed rhabdomyolysis during sorafenib treatment after a stem cell transplant for AML.
- Discontinuation of sorafenib and supportive care led to recovery of muscle enzyme levels and symptoms.
- Neuromuscular biopsy confirmed rhabdomyolysis and immune-mediated necrotizing myopathy.

## Abstract

Rhabdomyolysis is a clinical acute syndrome characterized by acute injury or necrosis of skeletal muscle cells and may be life-threatening. We report a rare case of rhabdomyolysis caused by sorafenib.

This case report presents a 31-year-old female patient who experienced rhabdomyolysis during sorafenib treatment following allogeneic hematopoietic stem cell transplantation. The patient underwent the transplantation due to acute myeloid leukemia (AML) and subsequently received sorafenib as maintenance therapy to prevent leukemia relapse. During treatment, she developed bilateral lower limb weakness, a significant increase in creatine kinase (CK) levels, and hypokalemia. After discontinuing sorafenib and initiating supportive treatments, her CK levels gradually decreased. Neuromuscular biopsy results showed rhabdomyolysis and immune-mediated necrotizing myopathy.The patient was followed up in the outpatient clinic after discharge, and the symptoms of myasthenia in both lower limbs have improved. On the 38th day after discharge, laboratory tests showed that the levels of α-hydroxybutyrate dehydrogenase, creatine kinase, lactate dehydrogenase, and electrolytes had returned to normal.

This case highlights that sorafenib may cause rare but severe adverse reactions, such as rhabdomyolysis. Clinicians should be vigilant about these potential adverse effects when using sorafenib and enhance patient monitoring and management.