Rhabdomyolysis secondary to Influenza A infection in a patient using antipsychotic and serotonergic agents: A case report

Influenza A infection is most commonly associated with pulmonary disease. However, viral infection can also rarely induce extrapulmonary complications, such as myocarditis, neuropsychiatric pathologies, and rhabdomyolysis. Influenza-A-induced rhabdomyolysis is an uncommon complication, and failure to appropriately address this pathology can quickly lead to deterioration into acute kidney injury. Recognizing this clinical presentation and differentiating it from viral myalgias is often difficult, as muscle aches are a common feature of Influenza A infection. This challenge is further exacerbated by the broad differential of rhabdomyolysis, including various medications such as antipsychotic and serotonergic medications. We report a case of an adult taking risperidone and trazodone presenting with profound myalgias and dark urine following Influenza A viral illness, who was found to have creatine kinase levels exceeding 60,000 U/L. We highlight relevant literature, discuss various proposed pathophysiological mechanisms, and highlight appropriate management strategies. Fluid resuscitation is a mainstay of management; however, iatrogenic fluid overload, such as pulmonary edema, is a possible complication that must be appropriately addressed. This case underscores the importance of maintaining a high index of suspicion for rhabdomyolysis in patients with Influenza A and presents a novel narrative of rhabdomyolysis resulting from a potentially additive interplay of pharmacological (use of trazodone and risperidone) and nonpharmacological predisposing factors.