Acute myoglobinuria with or without drug usage.

Abstract

To the Editor.— The report of Richter et al on myoglobinuria associated with heroin addiction ( 216 :1172 1971) described four patients with a syndrome involving skeletal muscles which was both clinically and pathologically distinctive. In each instance, onset of illness followed heroin use. Two of the four developed renal failure, presumably related to myoglobinuria. In one, death followed ten days of coma. With these exceptions, dysfunction of other organ systems was not striking, nor were there notable alterations in blood chemistry values (excluding, of course, elevation of enzyme levels reflecting muscle necrosis). Since May 1970, I have personally seen 17 patients with rhabdomyolysis and myoglobinuria, 1 15 at the Queens Hospital Center, two at the Long Island Jewish Medical Center. The diffuse inflammation of muscle described by Richter was the same, and the microscopic abnormalities in my patients were identical to those illustrated in their article. In no case could