Read this one. Can rhabdomyolysis be caused by using ankle weights while on ketoconazole? Can it occur using sulfasalazine?
Posted by
Captain Cronin
I was using ketoconazole 200 mg QD for 4 mos. from 10/01/2007 to 1/28/08 prescribed by a family physician. His diagnosis was "a yeast, fungus or a mold" infection. I had round patches on my skin with a raised border, not scaly. It looked like ringworm. During this time while on ketoconazole, I was walking/running for my workouts and warming up using ankle weights. I did not run or walk using ankle weights, but did leg lifts and tae boe kicks. My ankles started to ache as well as the back of my lower legs at night, but I did not connect it to the exercise as it occurred late at night. Sometimes at night during the winter, my ankles and feet became extremely cold. I reduced my workouts to walking only and stopped the ankle weights. By March 1, 2008 my ankles had small edema, were red and aching while also stinging. On March 5th, I could not walk. I tried to walk March 10th again after bed rest. I experienced weakness (could not spread my toes), severe pain, muscle spasms in my right foot, excessive thirst and low urine output. My right leg was swelling on the inside calf and somewhat red. I was seen by several doctors and no one could explain my problem and why I couldn't heal. I was given the diagnosis of posterior tibial tendonitis based on an MRI I had in June, 2008 which was otherwise unremarkable and months after the sx described above. I was in a wheelchair from March-July 2008 while receiving physical therapy and tests. In April 2008, my liver exzymes were elevated. The county RN explained they were likely coming down from the ketoconazole exposure earlier. I walked from July-September, 2008. In September of 2008 I was walking again 40 min. + could do errands around town, but tried to do small amounts of jumping with a physical trainer with the goal of regaining complete function. Slowly over the next 2-3 weeks, I started to loose function again and experience pain with weight bearing, e.g. standing and walking. I'm a female 5'8" UBW = 150 lbs., currently 170 lbs. and 44 years old. I have been in a wheel chair since October 5, 2008 until today August 11, 2009. I have tried to swim to stay active, but dependent upon someone to drive me to the gym. I was diagnosed with psoriatic arthritis April 2009 by a rheumatologist and placed on prednisone and methotrexate without definative testing or x-rays. I switched to Sulfasalazine due to reduced GFR and previous hx and my skin sx worsened while on MTX and consuming a regular diet. I'm currently taking prednisone 10 mg QD and Sulfasalazine 500 mg TID c meals, however, I have tapered myself down to 500-1000 mg/day due to upper back pain (where the kidneys are) unbalanced blood sugar and questioning if I have a correct diagnosis. By using a gluten-free and yeast-free diet, I can control my psoriasis (vs. fungus) on my abdomen. Now, I am starting to experience a little redness on my right ankle again and mild smarting, stinging and aching in my right ankle vs. last year it was both ankles. My right ankle will not heal. I am trying to drink plenty of fluids. An R.N. that I work with is confident that I likely experienced rhabdomyolysis during March of 2008. Why can't I heal now and am I at risk for rhabdomyolysis again with sulfasalazine? Do you know if rhabdomyolysis can reoccurr using sulfasalazine? I have heard that it can crystallize in the body.
Posted by Captain Cronin
I was using ketoconazole 200 mg QD for 4 mos. from 10/01/2007 to 1/28/08 prescribed by a family physician. His diagnosis was "a yeast, fungus or a mold" infection. I had round patches on my skin with a raised border, not scaly. It looked like ringworm. During this time while on ketoconazole, I was walking/running for my workouts and warming up using ankle weights. I did not run or walk using ankle weights, but did leg lifts and tae boe kicks. My ankles started to ache as well as the back of my lower legs at night, but I did not connect it to the exercise as it occurred late at night. Sometimes at night during the winter, my ankles and feet became extremely cold. I reduced my workouts to walking only and stopped the ankle weights. By March 1, 2008 my ankles had small edema, were red and aching while also stinging. On March 5th, I could not walk. I tried to walk March 10th again after bed rest. I experienced weakness (could not spread my toes), severe pain, muscle spasms in my right foot, excessive thirst and low urine output. My right leg was swelling on the inside calf and somewhat red. I was seen by several doctors and no one could explain my problem and why I couldn't heal. I was given the diagnosis of posterior tibial tendonitis based on an MRI I had in June, 2008 which was otherwise unremarkable and months after the sx described above. I was in a wheelchair from March-July 2008 while receiving physical therapy and tests. In April 2008, my liver exzymes were elevated. The county RN explained they were likely coming down from the ketoconazole exposure earlier. I walked from July-September, 2008. In September of 2008 I was walking again 40 min. + could do errands around town, but tried to do small amounts of jumping with a physical trainer with the goal of regaining complete function. Slowly over the next 2-3 weeks, I started to loose function again and experience pain with weight bearing, e.g. standing and walking. I'm a female 5'8" UBW = 150 lbs., currently 170 lbs. and 44 years old. I have been in a wheel chair since October 5, 2008 until today August 11, 2009. I have tried to swim to stay active, but dependent upon someone to drive me to the gym. I was diagnosed with psoriatic arthritis April 2009 by a rheumatologist and placed on prednisone and methotrexate without definative testing or x-rays. I switched to Sulfasalazine due to reduced GFR and previous hx and my skin sx worsened while on MTX and consuming a regular diet. I'm currently taking prednisone 10 mg QD and Sulfasalazine 500 mg TID c meals, however, I have tapered myself down to 500-1000 mg/day due to upper back pain (where the kidneys are) unbalanced blood sugar and questioning if I have a correct diagnosis. By using a gluten-free and yeast-free diet, I can control my psoriasis (vs. fungus) on my abdomen. Now, I am starting to experience a little redness on my right ankle again and mild smarting, stinging and aching in my right ankle vs. last year it was both ankles. My right ankle will not heal. I am trying to drink plenty of fluids. An R.N. that I work with is confident that I likely experienced rhabdomyolysis during March of 2008. Why can't I heal now and am I at risk for rhabdomyolysis again with sulfasalazine? Do you know if rhabdomyolysis can reoccurr using sulfasalazine? I have heard that it can crystallize in the body.