Rifaximin-Induced Rhabdomyolysis

TL;DR

A patient with cirrhosis and long-term statin use developed rhabdomyolysis after taking rifaximin, highlighting a rare but serious side effect.

Contribution

This case report adds to the understanding of rifaximin-induced rhabdomyolysis, particularly in patients with cirrhosis and statin use.

Findings

The patient developed rhabdomyolysis after two weeks of rifaximin therapy.

Long-term atorvastatin use may have contributed to the rhabdomyolysis when combined with rifaximin.

Creatine kinase levels were monitored until resolution, indicating the progression and recovery of the condition.

Abstract

Rifaximin is a non-absorbable oral antibiotic widely used for the management of traveler's diarrhea, hepatic encephalopathy, and irritable bowel syndrome diarrhea type. Although rifaximin is generally tolerated, rare cases of rhabdomyolysis have been reported, particularly in patients with cirrhosis with and without statin therapy. We reported a case of a 62-year-old male with a history of liver cirrhosis (ascites), hepatocellular carcinoma, and coronary artery disease (post coronary artery bypass grafting (CABG)) who presented with abdominal distension, generalized weakness, proximal muscle pain, and dark urine, with five years of atorvastatin medication without side effects. He was initiated on rifaximin (two weeks) for hepatic encephalopathy, along with lactulose, before experiencing proximal muscle pain and generalized weakness. This article will highlight our patient who developed rhabdomyolysis after initiating rifaximin with long-term use of statin, the trends of creatine kinase till resolution, and the treatment instituted.

Figures