Rhabdomyolysis secondary to diarrhoea induced hypokalemia in a human immunodeficiency virus - seropositive patient

Hypokalemia with rhabdomyolysis caused by diarrhoea is uncommon in human immunodeficiency virus (HIV) infected patients. We report the case of a patient with HIV1 infection who presented with chronic diarrhoea that led to hypokalemia induced rhabdomyolysis and acute kidney injury (AKI). A 32 -year-old man, known to be HIV-1 seropositive who was on treatment with tenofovir, lamivudine, lopinavirand ritonavir, presented to the emergency department with 6 months history of diarrhoea and sudden onset of weakness of all 4 limbs of two days duration. On examination limb power was grade 3/5 with hypotonia and diminished reflexes. Laboratory investigations showed severe hypokalemia, low urinary potassium, normal anion-gap metabolic acidosis, markedly increased creatine kinase and mildly increased serum creatinine. He was diagnosed as having diarrhoea induced hypokalemic myopathy leading to rhabdomyolysis and AKI. With potassiumsupplements, antiprotozoal treatment and adequate hydration he improved significantly and is on regular follow-up. Patients presenting with hypokalemia should be closely monitored for rhabdomyolysis, because outcome is good with early treatment.