Exercise-induced exertional rhabdomyolysis

Rhabdomyolysis is a condition resulting from skeletal muscle breakdown that can present in several ways, ranging from no symptoms to a life threatening renal disorder. A variety of insults, including trauma, toxins, drugs, infections, and exercise, can lead to muscle breakdown. Complications include compartment syndrome, electrolyte imbalance, and cardiac arrest. Rhabdomyolysis is a clinical challenge due to the range of its presentations. We report a 22-year-old male college student who came to the emergency department with mild thigh soreness and dark urine. A full work-up showed his serum creatine kinase was significantly elevated to 178,786 U/L and he had acute kidney injury. Our patient had no toxin or drug exposure, no infection, no trauma, and no crush injuries, but he had attended a 45-minute spinning class several days prior to admission, indicating a case of exercise-induced exertional rhabdomyolysis. He was hospitalized and treated with IV hydration to protect his kidneys. After eight days of conservative treatment with IV fluids, the patient’s creatine kinase level normalized. This case illustrates that even patients with minimal risk factors for rhabdomyolysis can present with severe kidney injury requiring prolonged hospitalization.