Abstract
Case report
A 32-year-old African male presented with 10 hours of severe back pain. Initial computed tomography scan of the back showed no abnormality, and initial laboratory investigations were consistent with rhabdomyolysis. Despite stopping potential causative medications, aggressive intravenous hydration, and urine alkalinization, his creatinine kinase continued to steadily climb. Thirty-six hours after admission, a magnetic resonance imaging of his back was done because of new swelling over the right paraspinal muscles and loss of sensation in this region. Marked swelling of the right erector spinae muscles was observed, and right and left compartment pressure measurements were 108 and 21 mm Hg, respectively. He had urgent fasciotomy after which his rhabdomyolysis and pain recovered.
Conclusion
Our case highlights the need for early consideration of compartment syndrome as a possible cause of back pain in the setting of rhabdomyolysis. Rhabdomyolysis can present in the absence of late complications such as neurological and vascular compromise.
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Acknowledgements
The authors wish to thank Drs. Logan Moodley, Shabbir Alibhai, Jeff Singh, and Alicia Fernandez for their insightful suggestions.
Conflict of Interest
Drs. Minnema, Quraishi, and Prakash have no conflicts of interest. Dr. Fehlings holds the Krembil Chair in Neural Repair and Regeneration. Dr. Neligan held the Wharton Chair until June 2007. Funds donated by families to The University of Toronto are allocated by the respective chairs for research and faculty recruitment.
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Minnema, B.J., Neligan, P.C., Quraishi, N.A. et al. A Case of Occult Compartment Syndrome and Nonresolving Rhabdomyolysis. J GEN INTERN MED 23, 871–874 (2008). https://doi.org/10.1007/s11606-008-0569-1
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DOI: https://doi.org/10.1007/s11606-008-0569-1