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BMJ Case Reports 2018; doi:10.1136/bcr-2018-224272
  • Rare disease
  • CASE REPORT

Primary carnitine deficiency in a 57-year-old patient with recurrent exertional rhabdomyolysis

  1. Jean-Baptiste Chanson1
  1. 1 Neurologie, Hopitaux universitaires de Strasbourg, Strasbourg, France
  2. 2 Laboratoire de Diagnostic Génétique, Hopitaux universitaires de Strasbourg, Strasbourg, France
  3. 3 Physiopathologie des maladies neuromusculaires, Institut de Genetique et de Biologie Moleculaire et Cellulaire, Illkirch, France
  4. 4 Service de Biochimie, Hopital Bicetre, Le Kremlin-Bicetre, France
  1. Correspondence to Dr Jean-Baptiste Chanson, jean-baptiste.chanson{at}chru-strasbourg.fr
  • Accepted 18 May 2018
  • Published 11 June 2018

Summary

Rhabdomyolysis is an emergency requiring rapid diagnosis and suitable aetiological treatment. We describe the case of a 57-year-old man with recurrent exertional rhabdomyolysis who was diagnosed with systemic primary carnitine deficiency (SPCD). Clinical examination was normal, creatine kinase levels were elevated, plasma free carnitine concentration was mildly decreased, muscle biopsy demonstrated lipid accumulation, carnitine uptake in cultured fibroblasts was decreased and genetic analysis identified a homozygous pathologic c.1181_1183del in the SLC22A5 gene. Rhabdomyolysis did not recur after treatment with oral L-carnitine was introduced. SPCD is a rare autosomal recessive disorder of carnitine transportation usually manifesting as an infantile (hepatic) or a childhood myopathic (cardiac) condition and rarely affecting adults. Our case indicates that SPCD should be considered in the aetiological evaluation of adult patients with recurrent exertional rhabdomyolysis, even in the absence of myopathy and cardiomyopathy.

Footnotes

  • Contributors AE-L drafted the manuscript. All the authors substantially contributed to the gathering of data and revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests J-BC reports hospitality fees from LFB laboratory, Grifols and CSL Behring and speaker fees from CSL-Behring.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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