Case Presentation: An 18-year-old female with no known past medical history presented to the emergency department with hematuria, chills, cough, and body aches lasting approximately one week. On admission, she was afebrile with stable vital signs. Laboratory findings revealed a normal white blood cell count of 6 × 10³/μL, normal creatinine of 0.6 mg/dL, elevated alanine transaminase (ALT) of 1,018 U/L, aspartate transaminase (AST) of 2,851 U/L, and a markedly elevated creatine kinase (CK) >200,000 U/L, consistent with severe rhabdomyolysis. Chest X-ray and CT scan revealed multifocal bilateral consolidations in lungs consistent with community-acquired pneumonia. A respiratory pathogen panel detected Mycoplasma pneumoniae. She was treated with azithromycin and received aggressive intravenous hydration. Her CK level was monitored closely during the hospital stay. Extensive workup was done to rule out other causes of elevated liver enzymes.
Discussion: Mycoplasma pneumoniae is a common cause of community-acquired pneumonia, typically presenting with upper and lower respiratory symptoms. However, extrapulmonary manifestations are increasingly recognized, including dermatologic, hematologic, cardiac, neurologic, and renal complications. Rhabdomyolysis is an exceptionally rare manifestation, with only a few cases reported in the adult population.Our patient’s elevated CPK and transaminases, along with respiratory symptoms and imaging findings, highlight the systemic nature of her illness. Rhabdomyolysis, a potentially life-threatening condition, is characterized by high CPK levels and myoglobinuria, leading to organ damage, such as liver injury in this case. The degree of CPK elevation correlates with muscle damage. The exact cause of M. pneumoniae-induced rhabdomyolysis is unclear but may involve direct bacterial invasion, immune-mediated myositis, or a cytokine-driven inflammatory response that damages muscle tissue. Additionally, autoantibodies produced during the infection may further contribute to muscle injury.
Conclusions: Clinicians should be aware of the possible association between rhabdomyolysis and M. pneumoniae infection and should consider testing for M. pneumoniae when presented with a patient with idiopathic rhabdomyolysis. This case emphasizes the importance of recognizing systemic complications in patients with community-acquired pneumonia presenting with atypical symptoms, such as hematuria and myalgias.