Onset of paroxysmal myoglobinuria after tonsillectomy and adenoidectomy

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IDIOPATHIC paroxysmal myoglobinuria, a syndrome consisting of the acute onset of muscle pain, weakness, and the passing of dark urine in the absence of anemia or hemolysis, was described by Meyer-Betz1 in 1910. Now known as the Meyer-Betz syndrome, and formerly considered a rare disease, it has been more frequently reported since the advent of an electrophoretic method for the identification of myoglobin,2 and is now a well-documented entity the origin of which remains obscure. In most reported cases in the pediatric age group the patients have had a prior or an associated minor infection, or have undergone recent increased muscular exertion, but in at least two patients paroxysmal myoglobinuria occurred after operations.3, 4

The following case report is of an eight and one-half year old boy in whom idiopathic paroxysmal myoglobinuria developed after tonsillectomy and adenoidectomy.

Report of a Case

An eight and one-half year old Caucasian boy was transferred to Cleveland Clinic Hospital on May 12, 1966, when it was noted that the urine was dark red after he had undergone tonsillectomy and adenoidectomy. The operation was performed the previous day at another hospital, after meperidine hydrochloride and atropine medication, and with nitrous oxide-oxygen-fluothane anesthesia, and succinyl dicholine administered before intubation. The duration of operation was 55 minutes. Thirty minutes later, as the child awakened, a red flush was noted to spread over his entire body; respirations became rapid and shallow; the heart rate was 108; and rectal temperature was 103.4 F. There was no apparent bleeding. One . . .



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