COMPLICATIONS OF ACUTE EXERTIONAL RHABDOM YOLYSIS (MEYER-BETZ SYNDROME)

A few hours after a 15 km march a 19-year-old man developed a fever of 40 degrees C, accompanied by hemoptysis, tarry stools and pain in the thigh. On physical examination there was tenderness and swelling over the shoulders, upper arms and thighs as well as petechiae, bruises, h epatomegaly, pain on percussion over the kidney region and signs of hy povolaemia. There was leukocytosis (18 800/mu l) and increased creatin ase activity (3900 U/l, rising to 66 300 U/l after 24 h). The platelet count fell from 147 000 to 11 000/mu l, the fibrinogen level to 0.25 g/l. On the second day serum creatinine was 4.1 mg/dl, urine volume 50 ml/24h, urinary myoglobin concentration 120 000 mu g/l. The Quick val ue dropped to under 3%, while liver enzymes and bilirubin concentratio n rose. The rhabdomyolysis caused acute respiratory failure, despite s ymptomatic treatment of the acute renal failure and consumption coagul opathy. but after 8 weeks of intensive treatment the patient was disch arged without symptoms. No cause other than the preceding physical exe rtion was found for the rhabdomyolysis. Muscle biopsy revealed unspeci fic changes 41/2 months after discharge.