Bergner et al. Journal of Medical Case Reports 2011, 5:409 http://www.jmedicalcasereports.com/content/5/1/409 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Inflammatory myopathy and severe rhabdomyolysis induced by leuprolide acetate therapy for prostate cancer: a case report Michael Bergner1, Martin Rohacek2 and Paul Erne1* Abstract Introduction: Leuprolide acetate is a synthetic analog of gonadotropin-releasing hormone used for the treatment of prostate cancer. Its side effects are hot flashes, nausea, and fatigue. We report a case of a patient with proximal inflammatory myopathy accompanied by severe rhabdomyolysis and renal failure following the second application of leuprolide acetate. Drug withdrawal and steroid therapy resulted in remission within six weeks of the diagnosis. To the best of our knowledge, our case report describes the second case of leuprolide acetate-induced inflammatory myopathy and the first case of severe leuprolide acetate-induced rhabdomyolysis and renal failure in the literature. Case presentation: A 64-year-old Swiss Caucasian man was admitted to the hospital because of progressive proximal muscle weakness, dyspnea, and oliguria. He had been treated twice with leuprolide acetate in monthly doses. We performed a muscle biopsy, which excluded other causes of myopathy. The patient’s renal failure and rhabdomyolysis were treated with rehydration and steroid therapy. Conclusion: The aim of our case report is to highlight the rare but severe side effects associated with leuprolide acetate therapy used to treat patients with inflammatory myopathy: severe rhabdomyolysis and renal failure. Introduction The etiology of myopathy includes congenital disorders, immunologic processes, malignancies, infections, endo- crinopathies, alcohol ingestion and adverse drug reac- tions (particularly statins), immunosuppressive agents, and nucleoside analog reverse transcriptase inhibitors [1-5]. Drugs can exert myotoxic effects on muscles through mechanisms that are direct (for example, alco- hol ingestion, statins, or anti-malarial agents), immuno- logical (for example, interferon a), or indirect (for example, drug-induced hypokalemia, hyperthermia, or seizures). Myositis can be associated with different can- cers, mainly lung and breast cancers, but also prostate cancer. In one study, cancer was diagnosed in 9% of 396 patients with polymyositis, and of the 168 men with polymyositis, four had prostate cancer [6]. In another study, of 309 patients with dermatomyositis or * Correspondence: Paul.Erne@ksl.ch 1Department of Cardiology, Luzerner Kantonsspital, 6000 Luzern 16, Switzerland Full list of author information is available at the end of the article polymyositis, 11.9% had cancer and one of these had prostate cancer [7]. Myopathy might affect all muscles or only proximal muscles, as well as pharyngeal muscles. Case report A 64-year-old Swiss Caucasian man patient with weak urinary flow and an elevated serum prostate-specific antigen (PSA) level of 130 μg/L was diagnosed with ade- nocarcinoma of the prostate on the basis of a biopsy (Gleason grade G3, Gleason score 4 + 4 = 8). A chest X-ray obtained for further staging showed a solitary node 9 mm in size in the left lower lung lobe. A com- puted tomographic scan of the patient’s abdomen and skeletal nuclear scintigraphy revealed no further suspi- cious malignancies. Leuprolide acetate therapy delivered as a monthly dose was initiated. After two months of therapy, his serum PSA level decreased to 7 μg/L, and a chest X-ray showed complete regression of the lung node. A second dose of leuprolide acetate delivered every three months was applied. Two months later the patient was admitted to the hospital because of © 2011 Bergner et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.