Mechanism: unclear. One theory is malaria-related myositis. A second is microcirculatory obstruction with ischemia. A third is high fever. A fourth is tumor necrosis factors. A fifth is a concomitant cause of rhabdomyolysis.
Risk factors:
(1) severe myositis
(2) myoadenylate deaminase or other muscle enzyme deficiency
(3) severe hyperthermia
Features:
(1) severe acute malaria, usually due to Plasmodium falciparum
(2) severe myositis with rhabdomyolysis and muscle pain
(3) myoglobinemia and myoglobinuria
(4) variable elevation in serum creatine kinase
(5) variable acute renal failure
The absence of an elevated serum CK does not exclude the diagnosis (Yong et al) but the diagnosis would require demonstration of an elevated myoglobin in urine or serum.
Differential diagnosis:
(1) Blackwater fever (malaria with hemolysis, hemoglobinuria and renal failure)
(2) drug-induced rhabdomyolysis
(3) concurrent infection with myositis
(4) sickle cell related rhabdomyolysis
