230 - Critical Illness Myopathy in the setting of Prolonged Caloric Deficit from an Abusive Relationship

Critical Illness Myopathy

Case Description:

A previously healthy 33-year-old male was admitted to Palomar Health Rehabilitation Institute after hospitalization for hypoxemic respiratory failure requiring intubation. Complications included severe electrolyte disturbances and sepsis from bibasilar pneumonia. He required bronchoscopy with re-intubation for mucus plugging followed by tracheostomy. Further complications included pericardial effusion requiring pericardiocentesis, severe malnutrition with dysphagia necessitating PEG placement, superficial vein thrombosis, coagulopathy, thrombocytopenia, and a coccygeal wound with tendon and bone exposure managed with wound care and IV antibiotics. Neurologically, he sustained a seizure after head trauma. He also developed urinary retention with bladder distention on CT, likely due to detrusor failure in the setting of weakness and malnutrition, managed with intermittent catheterization. He experienced microcytic anemia treated with transfusion. During rehabilitation, his wounds improved, venous Doppler was negative for DVT, and his mental status and overall clinical condition gradually recovered.

Discussions: Critical illness myopathy (CIM) is a common complication in patients with prolonged hospitalization, ventilation, or systemic illness. This patient exhibited profound weakness, difficulty weaning from ventilation, and lasting functional impairment. His CIM was compounded by severe malnutrition from prolonged caloric deprivation in an abusive relationship. At 6’8’’ and 58 kg (BMI 14), extreme undernutrition led to muscle wasting, seizures, and poor physiologic reserve. Malnutrition also worsened dysphagia, impaired wound healing, and infection risk, underscoring the systemic consequences of nutritional neglect.

Conclusions:

This case illustrates the systemic impact of critical illness myopathy compounded by severe malnutrition from an abusive relationship. Prolonged hospitalization involved multiple complications, but coordinated multidisciplinary care, including neuropsychology support, led to gradual improvements in respiratory function, wound healing, nutrition, mobility, and cognition. It underscores the importance of early recognition of CIM, aggressive nutritional support, and integrated rehabilitation to optimize recovery and prevent long-term disability, particularly when psychosocial factors such as abuse and neglect are present.