Diffuse Subcutaneous Upper Extremity Edema in the Setting of Rhabdomyolysis: A Case Report

Introduction While exertional rhabdomyolysis (ER) can occur with any strenuous exercise, it is more common with exercise involving repetitive eccentric contractions than with concentric contractions (5). ER is the result of the breakdown of skeletal muscle fibers due to overexertion with muscle destruction, necrosis, loss of cell membrane integrity, and displacement of intracellular contents into the extracellular space (1). ER is a syndrome entailing muscle soreness, weakness, and possibly brown urine (13). Complications of ER may include acute kidney injury (AKI), compartment syndrome, hyperkalemia, disseminated intravascular coagulation (DIC), and hypocalcemia (1). Diagnosis of rhabdomyolysis is made by clinical evidence of muscle damage and the presence of circulatory muscle cell content including creatine kinase (CK) and myoglobin (16). Elevation in serum myoglobin declines rapidly and may not be present at the time of presentation. Urine myoglobin test may take several days so it cannot be relied upon for treatment decisions. It is generally acknowledged that an increase in CK of five times the upper limit of normal, with symptoms of muscle pain or muscle weakness, and dark urine in the setting of strenuous activity are indicative of ER (3,14).