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Image Credit: Image from James Heilman, MD
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University of California San Francisco
Case: A previously healthy 18-year-old male comes in to the pediatric emergency department complaining of severe bilateral soreness and weakness of quadriceps and dark tea-colored urine for 1 day. Yesterday at the gym he performed heavy squats and lunges consecutively for one hour and drank minimal water. He denies recent URI symptoms or trauma.
Vitals are within normal limits. On exam, the patient’s anterior thighs are hard, swollen, and tender to touch and have limited passive and active range of motion. Sensation and capillary refill are normal in the distal lower extremities. Serum creatine kinase levels are 41,000; other labs include: BUN 14, Creatinine 0.73, Potassium 4.4, Phosphorus 3.8, Calcium 8.8. Urine dipstick is positive for blood, though no RBCs are seen on microscopy. MRI imaging shows edema and inflammation of the anterior compartment of the thighs, with patent blood vessels and no evidence of nerve damage (see image 1).
