20 June 2022
: Case report 
A Case of Exacerbation of Haloperidol-Induced Rhabdomyolysis Following the Onset of COVID-19
Unusual clinical course, Challenging differential diagnosis, Adverse events of drug therapy
Keisuke Takada1ABDEF*, Yukiyoshi Sada2ABDEF, Masaru Samura
1ABDEF, Masashi Matsuura1BDE, Naoki Hirose1DE, Takenori Kurata1DE, Fumio Nagumo1DE, Junichi Ishii1DE, Sakura Koshioka1DE, Masaki Uchida1DE, Junki Inoue1DE, Koji Tanikawa1DEF, Hiroyuki Kunishima3ADEF
DOI: 10.12659/AJCR.936589
Am J Case Rep 2022; 23:e936589
Table 1. Laboratory findings on admission.
| Hematology | |||
|---|---|---|---|
| Variable | Reference range | ||
| WBC | 3.9–9.8 | 3.2 | ×10/µL |
| Neut | 35.0–73.0 | 72.2 | % |
| Mono | 2.0–12.0 | 7.5 | % |
| Lym | 20.0–51.0 | 20.3 | % |
| Eos | 0.0–10.0 | 0 | % |
| Bas | 0.0–3.0 | 0 | % |
| RBC | 427–570 | 467 | ×10/µL |
| Hb | 13.5–17.6 | 14.9 | g/dL |
| Ht | 39.8–51.8 | 40.6 | % |
| PLT | 13.0–36.9 | 14 | ×10/µL |
| WBC – white blood cell count; Neut – neutrophils; Mono – monocytes; Lym – lymphocytes; Eos – eosinophils; Bas – basophils; RBC – red blood cell count; Hb – hemoglobin; Ht – hematocrit; PLT – platelet count; pCO – partial pressure of carbon dioxide; pO – partial pressure of oxygen; Lac – lactate; HCO3 – bicarbonate; BE – base excess; AnGap – anion gap; Ca – calcium; T-Bil – total bilirubin; AST – aspartate transaminase; ALT – alanine transaminase; ALP – alkaline phosphatase; LDH – lactate dehydrogenase; γGTP – γ-glutamyl transpeptidase; CK – creatine phosphokinase; ALB – albumin; BUN – blood urea nitrogen; SCr – serum creatinine; Na – sodium; K – potassium; Cl – chloride; BS – blood glucose; HbA1c – glycated hemoglobin; CRP – C-reactive protein; PCT – procalcitonin; PT-INR – prothrombin time-international normalized ratio; APTT – activated partial thromboplastin time. | |||
| Blood gas analysis (room air) | |||
| Variable | Reference range | ||
| pH | 7.35–7.45 | 7.479 | |
| pCO2 | 35–45 | 25.4 | mmHg |
| PO2 | 80–100 | 78.3 | mmHg |
| Lac | 0.37–1.67 | 1.64 | mmol/L |
| HCO3- | 20–26 | 18.4 | mmol/L |
| BE | −3.0–+3.0 | −3.2 | mmol/L |
| AnGap | 10–18 | 17.5 | mmol/L |
| Ca2+ | 1.13–1.32 | 1.10 | mmol/L |
| WBC – white blood cell count; Neut – neutrophils; Mono – monocytes; Lym – lymphocytes; Eos – eosinophils; Bas – basophils; RBC – red blood cell count; Hb – hemoglobin; Ht – hematocrit; PLT – platelet count; pCO – partial pressure of carbon dioxide; pO – partial pressure of oxygen; Lac – lactate; HCO3 – bicarbonate; BE – base excess; AnGap – anion gap; Ca – calcium; T-Bil – total bilirubin; AST – aspartate transaminase; ALT – alanine transaminase; ALP – alkaline phosphatase; LDH – lactate dehydrogenase; γGTP – γ-glutamyl transpeptidase; CK – creatine phosphokinase; ALB – albumin; BUN – blood urea nitrogen; SCr – serum creatinine; Na – sodium; K – potassium; Cl – chloride; BS – blood glucose; HbA1c – glycated hemoglobin; CRP – C-reactive protein; PCT – procalcitonin; PT-INR – prothrombin time-international normalized ratio; APTT – activated partial thromboplastin time. | |||
| Urines | |||
| Variable | Reference range | ||
| Specific gravity | 1.005–1.030 | 1.015 | |
| Urine pH | 4.8–7.5 | 5.0 | |
| Protein | Negative | 2+ | |
| Glucose | Negative | 4+ | |
| Acetone | Negative | 3+ | |
| Color, urine | Yellow | Red | |
| RBC, urine | 1–4 | per HPF | |
| WBC, urine | 1–4 | per HPF | |
| Myoglobin | <10 | 190×10 | ng/mL |
| WBC – white blood cell count; Neut – neutrophils; Mono – monocytes; Lym – lymphocytes; Eos – eosinophils; Bas – basophils; RBC – red blood cell count; Hb – hemoglobin; Ht – hematocrit; PLT – platelet count; pCO – partial pressure of carbon dioxide; pO – partial pressure of oxygen; Lac – lactate; HCO3 – bicarbonate; BE – base excess; AnGap – anion gap; Ca – calcium; T-Bil – total bilirubin; AST – aspartate transaminase; ALT – alanine transaminase; ALP – alkaline phosphatase; LDH – lactate dehydrogenase; γGTP – γ-glutamyl transpeptidase; CK – creatine phosphokinase; ALB – albumin; BUN – blood urea nitrogen; SCr – serum creatinine; Na – sodium; K – potassium; Cl – chloride; BS – blood glucose; HbA1c – glycated hemoglobin; CRP – C-reactive protein; PCT – procalcitonin; PT-INR – prothrombin time-international normalized ratio; APTT – activated partial thromboplastin time. | |||
| Blood chemistry | |||
| Variable | Reference range | ||
| T-Bil | 0.2–1.1 | 0.7 | mg/dL |
| AST | 10–40 | 769 | IU/L |
| ALT | 5–45 | 271 | IU/L |
| ALP | 38–113 | 42 | IU/L |
| LDH | 115–245 | 1134 | IU/L |
| γGTP | ≤75 | 85 | IU/L |
| CK | ≤160 | 41539 | IU/L |
| CK-MB | ≤25 | 109 | IU/L |
| ALB | 3.8–5.3 | 3.9 | g/dL |
| BUN | 8–22 | 15 | mg/dL |
| SCr | 0.61–1.04 | 0.82 | mg/dL |
| Na | 135–147 | 136 | mEq/L |
| K | 3.6–5.0 | 3.9 | mEq/L |
| Cl | 98–108 | 102 | mEq/L |
| BS | 70–109 | 107 | mg/dL |
| HbA1c | 4.6–6.2 | 7.6 | % |
| CRP | ≤0.30 | 6.11 | mg/dL |
| PCT | ≤0.05 | 0.30 | ng/mL |
| PT-INR | 0.88–1.17 | 1.19 | |
| APTT | 25.1–39.8 | 44.30 | SEC |
| D-dimer | <1.0 | 0.60 | µg/mL |
| Ferritin | 13–277 | 1158 | µg/mL |
| WBC – white blood cell count; Neut – neutrophils; Mono – monocytes; Lym – lymphocytes; Eos – eosinophils; Bas – basophils; RBC – red blood cell count; Hb – hemoglobin; Ht – hematocrit; PLT – platelet count; pCO – partial pressure of carbon dioxide; pO – partial pressure of oxygen; Lac – lactate; HCO3 – bicarbonate; BE – base excess; AnGap – anion gap; Ca – calcium; T-Bil – total bilirubin; AST – aspartate transaminase; ALT – alanine transaminase; ALP – alkaline phosphatase; LDH – lactate dehydrogenase; γGTP – γ-glutamyl transpeptidase; CK – creatine phosphokinase; ALB – albumin; BUN – blood urea nitrogen; SCr – serum creatinine; Na – sodium; K – potassium; Cl – chloride; BS – blood glucose; HbA1c – glycated hemoglobin; CRP – C-reactive protein; PCT – procalcitonin; PT-INR – prothrombin time-international normalized ratio; APTT – activated partial thromboplastin time. | |||