First Reported Case of Rhabdomyolysis Associated with Concomitant Use of Cyclosporin, Diltiazem, and Simvastatin.

Rhabdomyolysis is a syndrome with a wide range of symptoms ranging from asymptomatic raised serum creatinine kinase to life-threatening metabolic disturbances and acute kidney injury. A careful history taking and high clinical suspicion on drug-drug interaction are crucial to identify the etiology of rhabdomyolysis. Here, we present a case of rhabdomyolysis due to a rare drug-to-drug interaction of simvastatin, diltiazem, and cyclosporin in a patient with IgA nephropathy. Early renal replacement therapy was initiated, and the insulting agents were withheld. Despite the metabolic disturbances were corrected, the patient succumbed to possible venous thromboembolism event during the prolonged hospital stay. Therefore, heightened awareness is required in dealing with patients with glomerulonephritis who are frequently prescribed on polypharmacy, in order to reduce unwarranted adverse events.