Myoglobinuria caused by exertional rhabdomyolysis misdiagnosed as psychiatric illness.
BACKGROUND
Rhabdomyolysis is severe and acute skeletal muscle damage resulting in sarcolemma disruption. During injury, intracellular muscle contents are released into the plasma. The consequences may cause hypovolemia, electrolyte abnormalities, compartment syndrome, or even acute renal failure and dialysis.


METHODS
We present the history of a patient in whom exertional rhabdomyolysis was misdiagnosed. A 20-year-old male police recruit was admitted to a psychiatric hospital because of complaints about black urine and severe thigh pain. Serum creatinine kinase (CK) was significantly elevated at 87,335 U/l. Urinalysis showed brown color and cloudiness. Serum myoglobin was also significantly increased. Aspartate aminotransferase was elevated as was alanine aminotransferase. Immediate intravascular fluid hydration and hospital rest under renal, metabolic, and hematological monitoring was performed.


CONCLUSIONS
Gymnastic teachers and people at environmental risk of rhabdomyolysis, such as members of the armed forces, police, and supervisors of physical laborers, need to remember the risks of intensive and repetitive exercise. Symptoms such as dark urine, myalgia, and muscle weakness should immediately arouse suspicion of rhabdomyolysis. Especially dark-colored urine should always be investigated for the occurrence of rhabdomyolysis.
Banasik
Mirosław
M
Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland. m.banasik@interia.pl
Kuźniar
Jakub
J
Kusztal
Mariusz
M
Porazko
Tomasz
T
Weyde
Waclaw
W
Klinger
Marian
M
D000328:Adult; D003951:Diagnostic Errors; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis; D009212:Myoglobinuria / Q000175:diagnosis* / Q000209:etiology* / Q000523:psychology; D005082:Physical Exertion / Q000502:physiology*; D012206:Rhabdomyolysis / Q000150:complications* / Q000175:diagnosis* / Q000523:psychology / Q000652:urine