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Case Report
Myoglobin cast nephropathy long after an unevaluated febrile episode with no clinical evidence of rhabdomyolysis: A rare cause of reversible AKI—A case report
1 Senior consultant nephrologist and transplant physician, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur District, Tamil Nadu, India
2 Pathologist, Nextgen Path Diagnostics, Coimbatore District, Tamil Nadu, India
3 Consultant nephrologist, Pinapple Dialysis Centre, Tiruchirapalli District, Tamil Nadu, India
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Rajesh Jayaraman
Consultant nephrologist and transplant physician, Department of Nephrology and Renal Sciences, Dhanalakshmi Srinivasan Medical College and Hospital, Trichy-Chennai Highway, Perambalur District, Tamil Nadu,
India
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Article ID: 101507Z01RJ2025
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Jayaraman R, Louis B, Tholappan R, Subramanian VA. Myoglobin cast nephropathy long after an unevaluated febrile episode with no clinical evidence of rhabdomyolysis: A rare cause of reversible AKI—A case report. Int J Case Rep Images 2025;16(1):101–105.ABSTRACT
Introduction: Rhabdomyolysis/myoglobin cast nephropathy constitutes a rare yet a reversible cause of acute kidney injury (AKI) in the critical care setting. We hereby report a case of a full-blown myoglobin cast nephropathy that occurred weeks after an unevaluated febrile illness but with a completely normal urine and serum biochemistry pertaining to myoglobin during the presentation.
Case Report: A 45-year-old man presented with features of AKI. Three weeks before the presentation he had an unevaluated febrile illness. His renal biopsy revealed strongly positive immunohistochemical-staining myoglobin with no other discernible cause. All the urinary and serum biomarkers pertaining to rhabdomyolysis, such as urine free myoglobin and creatine phosphokinase (CPK-MB), were negative. The patient responded completely to urine alkalinization and hydration.
Conclusion: Rhabdomyolysis is a rare yet a potentially reversible cause of AKI in the critical care settings. Our case ascertains the fact that a full-blown myoglobin cast nephropathy/AKI can still occur days to weeks after a febrile illness. Our study also stretches the clinical importance of suspecting a full-blown myoglobin cast nephropathy despite all the markers in urine and serum proving to be negative.
Keywords: Myoglobin cast nephropathy, Negative urine myoglobin, Post-febrile status, Reversible AKI
SUPPORTING INFORMATION
Author Contributions
Rajesh Jayaraman - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Balan Louis - Analysis of data, Drafting the article, Final approval of the version to be published
Rajendran Tholappan - Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Vel Arvind Subramanian - Acquisition of data, Drafting the article, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Rajesh Jayaraman et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
