{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:37:40Z","timestamp":1787017060870,"version":"build-2736575974"},"reference-count":19,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,11,21]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Rhabdomyolysis is characterised by muscle breakdown which causes myoglobin light chain release and can result in renal injury. While some of the most common causes of rhabdomyolysis are trauma related, others include toxins, autoimmune processes or viral aetiologies. We present the case of a 20s-year-old man, with no significant medical history, who presented to the emergency department with a 1-week history of weakness, myalgias, nausea, vomiting and subjective fevers. A review of systems and physical exam were otherwise unremarkable, including being negative for sore throat, dysphagia and lymphadenopathy. On presentation, the patient was noted to have dark urine with a creatine kinase value of 452\u2009458\u2009U\/L and an elevated creatinine at 7.23\u2009mg\/dL. The patient denied any trauma or increased physical activity. His toxin screen and autoimmune workup were negative. The patient\u2019s serological workup was significant for acute Epstein-Barr virus (EBV) infection, without additional viral coinfection or mononucleosis. During his hospitalisation course, the patient was managed with supportive care including haemodialysis. The patient made a full renal recovery and was discharged with scheduled outpatient follow-up. This case highlights the recognition of an acute EBV infection causing rhabdomyolysis in the absence of mononucleosis or concomitant infection.<\/jats:p>","DOI":"10.1136\/bcr-2023-256313","type":"journal-article","created":{"date-parts":[[2023,12,16]],"date-time":"2023-12-16T11:45:33Z","timestamp":1702727133000},"page":"e256313","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Acute myositis secondary to Epstein-Barr virus in the absence of infectious mononucleosis with severe rhabdomyolysis"],"prefix":"10.1136","volume":"16","author":[{"given":"Adam","family":"Tuchinsky","sequence":"first","affiliation":[{"name":"Internal Medicine, UPMC-Lititz, Lititz, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Montalvo","sequence":"additional","affiliation":[{"name":"Internal Medicine, UPMC-Lititz, Lititz, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dale","family":"Lent","sequence":"additional","affiliation":[{"name":"Internal Medicine, UPMC-Lititz, Lititz, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Goldman","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, UPMC-Harrisburg, Harrisburg, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,16]]},"reference":[{"key":"2025082710314143000_16.12.e256313.1","unstructured":"Centers for disease control and prevention . Epstein-Barr virus and infectious mononucleosis: laboratory testing. 2020. Available: https:\/\/www.cdc.gov\/epstein-barr\/laboratorytesting.html [Accessed 27 Nov 2022]."},{"key":"2025082710314143000_16.12.e256313.2","doi-asserted-by":"crossref","DOI":"10.3390\/v9110341","article-title":"Epstein-Barr virus hijacks DNA damage response transducers to orchestrate its life cycle","volume":"9","author":"Hau","year":"2017","journal-title":"Viruses"},{"key":"2025082710314143000_16.12.e256313.3","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s00508-021-01866-3","article-title":"Acute viral myositis: profound rhabdomyolysis without acute kidney injury","volume":"133","author":"Kietaibl","year":"2021","journal-title":"Wien Klin Wochenschr"},{"key":"2025082710314143000_16.12.e256313.4","unstructured":"Ferri F , Fort G . Chapter: Epstein-Barr virus infection. In: 2022 Ferri\u2019s clinical advisor. 1st ed. Elsevier, 2022: 592\u20133."},{"key":"2025082710314143000_16.12.e256313.5","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/132.5.546"},{"key":"2025082710314143000_16.12.e256313.6","doi-asserted-by":"crossref","DOI":"10.1098\/rstb.2016.0271","article-title":"Epstein-Barr virus-associated lymphomas","volume":"372","author":"Shannon-Lowe","year":"2017","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"key":"2025082710314143000_16.12.e256313.7","doi-asserted-by":"publisher","DOI":"10.1007\/s12026-014-8496-1"},{"key":"2025082710314143000_16.12.e256313.8","unstructured":"Salman B , Elie N , Mazen D . Overview of viral myositis. UpToDate; 2022. Available: https:\/\/www.uptodate.com\/contents\/overview-of-viral-myositis [Accessed 27 Nov 2023]."},{"key":"2025082710314143000_16.12.e256313.9","doi-asserted-by":"publisher","DOI":"10.1177\/000992288602500412"},{"key":"2025082710314143000_16.12.e256313.10","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/0735-6757(88)90244-6","article-title":"Epstein-Barr virus infection complicated by acute rhabdomyolysis","volume":"6","author":"McCabe","year":"1988","journal-title":"Am J Emerg Med"},{"key":"2025082710314143000_16.12.e256313.11","unstructured":"Centers for Disease Control and Prevention . Rhabdomyolysis: what is rhabdo? 2019. Available: https:\/\/www.cdc.gov\/niosh\/topics\/rhabdo\/what.html [Accessed 27 Nov 2023]."},{"key":"2025082710314143000_16.12.e256313.12","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/00007611-197803000-00040","article-title":"Infectious mononucleosis associated with rhabdomyolysis and renal failure","volume":"71","author":"Kantor","year":"1978","journal-title":"South Med J"},{"key":"2025082710314143000_16.12.e256313.13","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.ajem.2008.07.022","article-title":"Viral myositis leading to rhabdomyolysis: a case report and literature review","volume":"27","author":"Nauss","year":"2009","journal-title":"Am J Emerg Med"},{"key":"2025082710314143000_16.12.e256313.14","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1978.03630270058020"},{"key":"2025082710314143000_16.12.e256313.15","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1996.48"},{"key":"2025082710314143000_16.12.e256313.16","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jcv.2017.03.016","article-title":"Acute kidney injury in symptomatic primary Epstein-Barr virus infectious mononucleosis: systematic review","volume":"91","author":"Moretti","year":"2017","journal-title":"J Clin Virol"},{"key":"2025082710314143000_16.12.e256313.17","first-page":"428","article-title":"Myoglobinuria associated with mononucleosis","volume":"32","author":"Zappacosta","year":"1972","journal-title":"J Am Med Womens Assoc"},{"key":"2025082710314143000_16.12.e256313.18","doi-asserted-by":"publisher","DOI":"10.1007\/BF01833879"},{"key":"2025082710314143000_16.12.e256313.19","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.52.3.412"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-256313","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:31:48Z","timestamp":1756315908000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-256313"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":19,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12,16]]},"published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1136\/bcr-2023-256313"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-256313","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12]]}}}