Idiopathic Paroxysmal Myoglobinuria
Authors: DAVID E. COMINGS
Journal: Annals of Internal Medicine (1961)

Case Reports1 October 1961Idiopathic Paroxysmal MyoglobinuriaDAVID E. COMINGS, M.D., HARRY ROSENFELD, M.D.DAVID E. COMINGS, M.D.Search for more papers by this author, HARRY ROSENFELD, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-55-4-647 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIdiopathic paroxysmal myoglobinuria is a rare syndrome consisting basically of the spontaneous onset of muscle pain and swelling followed by myoglobinuria and frequently complicated by oliguria or anuria due to myoglobininduced renal damage. The muscles most frequently affected are the muscles of the calf and the thigh, but abdominal, thoracic, cervical, masseter, and upper extremity muscle groups have also been involved. Associated symptoms in some cases include fever, chills, abdominal pain, diarrhea, vomiting, and pseudoparalysis of the affected muscle groups. Almost all of the reported cases have shown some degree of renal involvement, varying from albuminuria, cylindruria, and oliguria to...References1. MEYER-BETZ F: Beobachtungen an einem Eigenartigen mit Muskellahmungen Verbundenen Fall von Hamoglobinuria. Deutsch. Arch. Klin. Med. 101: 85, 1910. Google Scholar2. PAUL F: Uber einem Fall von Paralytischer Hämoglobinurie beim Menschen. Wien. Arch. Inn. Med. 7: 531, 1924. Google Scholar3. GUNTHER H: Kasuistische Mitteilung uber Myositis Myoglobinurica. Virchow. Arch. Path. Anat. 251: 141, 1924. CrossrefGoogle Scholar4. HITTMAIR A: Häemoglobinuria paroxysmalis paralytica. Wien. Klin. Wschr. 38: 431, 1925. Google Scholar5. DEBREGERNEZSEE RGG: Crises myopathiques paroxystiques avec hemoglobinurie. Bull. Soc. Med. Hop. Paris 50: 1640, 1934. Google Scholar6. HUBERFLORANDLIEVRENERET JJJAM: Crises myopathiques paroxystiques avec hemoglobinurie. Bull. Soc. Pediat. Paris 36: 96, 1938. Google Scholar7. MILLIKAN GA: Muscle myoglobin. Physiol. Rev. 10: 503, 1939. CrossrefGoogle Scholar8. BYWATERSDIBLE EDJH: Acute paralytic myohaemoglobinuria in man. J. Path. Bact. 55: 7, 1943. CrossrefGoogle Scholar9. LOUWNIELSON AHE: Paroxysmal paralytic hemoglobinuria. Acta Med. Scand. 117: 436, 1944. Google Scholar10. SCHERWIN AJ: Myoglobinuria paralytica. Nord. Med. 25: 460, 1945. Google Scholar11. DELANGEN CD: Myoglobin and myoglobinuria. Acta Med. Scand. 124: 213, 1946. CrossrefGoogle Scholar12. HED R: Familial forms of paroxysmal myoglobinuria. Nord. Med. 35: 1586, 1947. Google Scholar13. KREUTZERSTRAITKERR FLLUJ: Spontaneous myohemoglobinuria in man. Arch. Intern. Med. 81: 249, 1948. CrossrefGoogle Scholar14. WISSLER H: Paroxysmal myoglobinurie. Helv. Paediat. Acta 3: 334, 1948. MedlineGoogle Scholar15. SCHAARLABREEGLEASON FEJWDF: Paroxysmal myohemoglobinuria with fatal renal tubular injury. J. Lab. Clin. Med. 34: 1744, 1949. Google Scholar16. BUCHANANSTEINER DPE: Myoglobinuria with paralysis. Arch. Neurol. Psychiat. 66: 107, 1951. MedlineGoogle Scholar17. ELKANDERSON SDHF: Paroxysmal paralytic myoglobinuria. Brit. Med. J. 2: 533, 1953. CrossrefMedlineGoogle Scholar18. HED R: Myoglobinuria. Arch. Intern. Med. 92: 825, 1953. CrossrefGoogle Scholar19. ACHESONMCALPINE DD: Muscular dystrophy associated with paroxysmal myoglobinuria and excessive excretion of ketosteroids. Lancet 2: 372, 1953. CrossrefGoogle Scholar20. SPAETROSENTHALDAMESHEK TMMCW: Idiopathic myoglobinuria in man. Blood 9: 881, 1954. CrossrefMedlineGoogle Scholar21. HIPPSHUKERS HRCF: Spontaneous myoglobinuria: report of a case with symptoms of myotonia. Ann. Intern. Med. 42: 197, 1955. LinkGoogle Scholar22. BERENBAUMBIRCHMORELAND MCCAJD: Paroxysmal myoglobinuria. Lancet 1: 892, 1955. CrossrefGoogle Scholar23. FLETCHERPRANKERD WDTA: Paroxysmal myoglobinuria. Lancet 1: 1072, 1955. CrossrefGoogle Scholar24. HED R: Myoglobinuria in man. Acta Med. Scand. Suppl. 303, 1955. MedlineGoogle Scholar25. FAHLGRENHEDLUNDMARK HRC: Myonecrosis and myoglobinuria in alcohol and barbiturate intoxication. Acta Med. Scand. 158, 405, 1957. CrossrefMedlineGoogle Scholar26. BOWDENFRASERJACKSONWALKER DHDSHNF: Acute recurrent rhabdomyolysis. Medicine 35: 335, 1956. CrossrefMedlineGoogle Scholar27. REINERKONIKOFFALTSCHULEDAMMINMERRILL LNMDGJJP: Idiopathic paroxysmal myoglobinuria. Arch. Intern. Med. 97: 537, 1956. CrossrefGoogle Scholar28. PEARSONBECKBLAHD CMWSWM: Idiopathic paroxysmal myoglobinuria: detailed study of a case including radioactive isotope and serum enzyme determinations. Arch. Intern. Med. 99: 376, 1957. CrossrefGoogle Scholar29. BERGFRENKEL PEP: Myoglobinuria after spontaneous and induced fever: report of a case. Ann. Intern. Med. 48: 380, 1958. LinkGoogle Scholar30. SEGAR WE: Idiopathic paroxysmal myoglobinuria. Pediatrics 23: 12, 1959. MedlineGoogle Scholar31. KAUFMANBARRY RPPE: Rhabdomyolysis with myoglobinuria. New Engl. J. Med. 260: 430, 1959. CrossrefMedlineGoogle Scholar32. GILLETT RL: Primary myoglobinuria. New Engl. J. Med. 260: 1136, 1959. CrossrefGoogle Scholar33. WHISNANTOWINGSCANTRELLCOOPER CLRHCGGR: Primary idiopathic myoglobinuria in a Negro female: its implications and a new method of laboratory diagnosis. Ann. Intern. Med. 51: 140, 1959. LinkGoogle Scholar34. JAVIDHOROWITZSANDERSSPAET JHIARTH: Idiopathic paroxysmal myoglobinuria. Arch. Intern. Med. 104: 132, 1959. CrossrefGoogle Scholar35. PHILLIPPIJONESKENOYER PJFRWL: Idiopathic paroxysmal myoglobinuria. J. A. M. A. 172: 907, 1960. CrossrefMedlineGoogle Scholar36. VALAITISPILTZOLINERCHOMET JCGHBJ: Myoglobinuria, myoglobinuric nephrosis and alcoholism. Arch. Path. To be published. Google Scholar37. VALAITISPILTZOLINERCHOMET JCGHBJ: Personal communication. Google Scholar38. ONO L: Studies on myoglobin. Tohoku J. Exp. Med. 57: 273, 1953. CrossrefMedlineGoogle Scholar39. BYWATERSSTEAD EGJK: Thrombosis of the femoral artery with myohaemoglobinuria and low serum potassium concentration. Clin. Sci. 5: 195, 1945. MedlineGoogle Scholar40. BLONDHEIMMARGOLIASHSHAFRIR SHEE: A simple test for myoglobin. J. A. M. A. 167: 453, 1958. CrossrefMedlineGoogle Scholar41. YUILECLARK CLWF: Myohemoglobinuria: a study of the renal clearance of myoglobin in dogs. J. Exp. Med. 74: 187, 1941. CrossrefMedlineGoogle Scholar42. GILLIGANALTSCHULEKATERSKY DRMDEM: Studies of hemoglobinemia and hemoglobinuria produced in man by intravenous injection of hemoglobin solutions. J. Clin. Invest. 20: 177, 1941. CrossrefMedlineGoogle Scholar43. LAURELLNYMAN CBM: Studies on the serum haptoglobin level in hemoglobinemia and its influence on renal excretion of hemoglobin. Blood 12: 493, 1957. CrossrefMedlineGoogle Scholar44. ALLISONREES ACW: The binding of hemoglobin by plasma proteins (haptoglobins). Its bearing on the "renal threshold" for hemoglobin in the etiology of hemoglobinuria. Brit. Med. J. 2: 1137, 1957. CrossrefMedlineGoogle Scholar45. BYWATERSDELORYREMINGTONSMILES EGGECJ: Myohemoglobin in the urine of air raid casualties with crushing injury. Biochem. J. 35: 1164, 1941. CrossrefMedlineGoogle Scholar46. LUCKE B: Lower nephron nephrosis. Milit. Surg. 99: 371, 1946. CrossrefMedlineGoogle Scholar47. FISCHERROSSIER HPH: Starkstrommunfälle mit schweren Muskelschadigungen und Myoglobinurie. Helv. Med. Acta 14: 212, 1947. MedlineGoogle Scholar48. BERLIN R: Haff disease in Sweden. Acta Med. Scand. 129: 560, 1948. CrossrefMedlineGoogle Scholar49. JASINSKIBRUTSCH BH: Zur Pathogenese Prognose und Therapie Thraumatischer Myoglobinurien. Schweiz. Med. Wschr. 82: 29, 1952. MedlineGoogle Scholar50. TOUZÉTHIERRY JM: Hemoglobinurie due à une attrition musculaire localisé (form fruste de syndrome de Bywaters). Bull. Soc. Med. Hop. Paris 68: 971, 1952. MedlineGoogle Scholar51. CARLSTROM B: Uber die Atiologie und Pathogenese der Kreuzlahme des Pferdes. Scand. Arch. Physiol. 61: 161 and 63: 164, 1931. CrossrefGoogle Scholar52. GRZYCKI S: Equine myoglobinuria. Quoted from abstract in Vet. Rec. 15: 1346, 1935. Google Scholar53. PRANKERD TA: Electrophoretic properties of myoglobin and its character in sickle cell disease and paroxysmal myoglobinuria. Brit. J. Haemat. 2: 80, 1956. CrossrefMedlineGoogle Scholar54. HUXLEY HE: The double array of filaments in cross-striated muscle. J. Biophys. Biochem. Cytol. 3: 631, 1957. CrossrefMedlineGoogle Scholar55. HANSONHUXLEY JHE: The structural basis of contraction in striated muscle, in Symposia Soc. Exp. Biol. No. IX: 228, 1955. Google Scholar56. SZENT-GYORGYI A: Chemical Physiology of Contraction in Body and Heart Muscle, Academic Press, New York, 1953. Google Scholar57. WEBER HH: The Motility of Muscle and Cells, Harvard University Press, Cambridge, Mass., 1958. CrossrefGoogle Scholar58. MARSH BB: The effect of adenosine triphosphate on the fiber volume of a muscle homogenate. Biochem. Biophys. Acta 9: 247, 1952. CrossrefMedlineGoogle Scholar59. GOODALLSZENT-GYORGYI MCAG: Relaxing factor in muscle. Nature 172: 84, 1953. CrossrefMedlineGoogle Scholar60. HOAGLAND CL: Some biochemical problems posed by a disease of muscle, in Currents in Biochemical Research, ed. by Green, D. E., Interscience Publishers, Inc., New York, 1946. Google Scholar61. MILHORAT AT: Observations on the pathogenesis of muscular dystrophy, in Proc. First and Second Med. Conf. Muscular Dystrophy Ass. of Amer., Inc., 1951-52, p. 78. Google Scholar62. WHISNANTCOOPERCANTRELLOWINGS CLGRCGRH: Diagnosis of myoglobinuria with special reference to the primary type in man. J. Med. Ass. Georgia 45: 507, 1956. MedlineGoogle Scholar63. SCHMIDHAMMAKER RL: Hereditary absence of muscle phosphorylase (McArdle's syndrome). New Engl. J. Med. 264: 223, 1961. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Chicago, IllinoisReceived for publication May 17, 1960.From the Hekton Institute for Medical Research, Cook County Hospital, Chicago, Ill.Requests for reprints should be addressed to David E. Comings, M.D., Cook County Hospital, Chicago, Ill. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByMuscle DiseasesMyoglobin: Methods and Diagnostic UsesMyoglobinuriaMyoglobinuriaIdiopathic Paroxysmal Myoglobinuria with Acute Renal Failure and HypercalcemiaMyoglobinuric Myopathy A Clinical, Histological, and Biochemical StudyCONSTANTINE L. HAMPERS, M.D., DAVID PRAGER, M.D.Genetics and diseases of muscleIdiopathic recurrent rhabdomyolysisMedical genetics 1961 1 October 1961Volume 55, Issue 4Page: 647-661KeywordsBlood pressureBlood urea nitrogenHemoglobinInflammationMusclesMyalgiaPaper electrophoresisTemperatureUrineWhite blood cells Issue Published: 1 October 1961 PDF DownloadLoading ...