SHM Converge Scientific Abstract ePoster Gallery-Beyond the Workout: When Rhabdomyolysis Refuses to Resolve

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This case describes a 32-year-old woman who presented with diffuse myalgias, generalized weakness, and mild nausea after an exercise class. Her initial CK was markedly elevated at 22,000 U/L, so she was treated as having exertional rhabdomyolysis with aggressive IV fluids. However, after three days of hydration, her CK remained unchanged at over 22,000 U/L and her symptoms persisted, which raised concern that the diagnosis was something other than simple exertional muscle injury.<br /><br />On hospital day 3, IV corticosteroids were started because an inflammatory myopathy was suspected. Within 24 hours, her CK fell to 15,000 U/L and then to 8,000 U/L the next day, with clear clinical improvement. Autoimmune testing, including ANA, anti–Jo-1, and other myositis-specific antibodies, was sent to evaluate for idiopathic inflammatory myopathy.<br /><br />The key teaching point is that rhabdomyolysis is commonly caused by exertion, trauma, toxins, heat injury, or seizures, and is usually managed with supportive care such as fluids and electrolyte correction. But when CK remains markedly elevated despite adequate hydration, or when weakness and myalgias do not improve, clinicians should reconsider the diagnosis. Idiopathic inflammatory myopathies, including polymyositis, immune-mediated necrotizing myopathy, and antisynthetase-spectrum disease, can mimic exertional rhabdomyolysis, even after minor exercise.<br /><br />This case emphasizes the importance of tracking CK trends in clinical context and recognizing “red flags” such as persistent CK elevation and ongoing weakness. If the diagnosis remains uncertain, further workup may include ANA, myositis-specific antibodies, aldolase, thyroid studies, MRI, EMG, and possibly muscle biopsy.

Asset Subtitle

Zoya Khan

Meta Tag

Author List Ardit Feinaj, Monica Correa-Alfonzo, Satyajeet Singh, Vivan Loveday-Laghi, Zoya Khan

Category Clinical Vignettes

Concept Creatine Kinase Elevation

Concept Non-Traumatic Rhabdomyolysis

Concept Idiopathic Inflammatory Myositis

Concept Weakness

Concept Persistent Creatine Kinase Elevation

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health

Presenting Author Zoya Khan

Track Adult

Keywords

rhabdomyolysis

creatine kinase

exertional myopathy

inflammatory myopathy

polymyositis

immune-mediated necrotizing myopathy

antisynthetase syndrome

corticosteroids

myositis antibodies

muscle weakness

Creatine Kinase Elevation

Non-Traumatic Rhabdomyolysis

Idiopathic Inflammatory Myositis

Weakness

Persistent Creatine Kinase Elevation