Cluster of exertional rhabdomyolysis in three young women

Abstract

Three young women, aged 18-24 years, presented to general practice with signs and symptoms of exertional rhabdomyolysis in 2016. All attended the same gym and had undertaken an intensive physical workout. Presenting symptoms were severe muscle pain and swelling, significantly reduced range of motion in affected muscles and, in two cases, dark-coloured urine. One case had presented to the out-of-hours service 4 months previously with similar symptoms but rhabdomyolysis was not considered, although retrospective history taking suggests that was the likely diagnosis. All three women were admitted to hospital, treated with intravenous fluids and discharged between 1 and 6 days later. All made a full recovery with no renal sequelae. The cases were questioned about potential risk factors, and the only commonality was unaccustomed strenuous exercise.

News and Views on Sports and Sports Medicine

“…I found a report on three young women in the United Kingdom who went to the same general practitioner (GP) for major ER, and that savvy GP, who had never seen such a cluster of ER in such a brief time frame, informed local public health officials, suspecting an ongoing public health risk. Sure enough, all three young women, although active individuals enjoying recreational sports, had done novel gym workouts, way beyond their ability, involving repetitive, explosive movements with many repetitions — in the same gym , led by two very intense physical trainers who promised to change their ways (6).…”

Molecular Mechanisms of Rhabdomyolysis-Induced Kidney Injury: From Bench to Bedside

“… 5 The incidence of RIAKI has increased 10-fold in the last decade, 6 fueled in part by popular interest in studio fitness training, such as CrossFit. 7 , 8 , 9 , 10 RIAKI is a significant comorbidity for injured soldiers who are are 3 to 4 times more likely to develop rhabdomyolysis than civilians. 11 It is also common in critically ill patients with COVID-19, because COVID-AKI shares many features with RIAKI even without specific markers of RIAKI.…”

Houston Mystery

“…Sparse previous reports of rhabdomyolysis in young women suggest that it is indeed a rare event and occurs only after an intense physical workout. 7 It can be misdiagnosed or confused with a less severe condition called DOMS: delayed onset muscle soreness. 7 DOMS usually begins the day after exercise and peaks on day 2 followed by improving symptoms.…”

“…7 It can be misdiagnosed or confused with a less severe condition called DOMS: delayed onset muscle soreness. 7 DOMS usually begins the day after exercise and peaks on day 2 followed by improving symptoms. Rhabdomyolysis begins the same day as the offending activity and can cause muscle swelling and more severe pain.…”

“…Rhabdomyolysis begins the same day as the offending activity and can cause muscle swelling and more severe pain. 7 The key factor in rhabdomyolysis is that it usually results from unaccustomed exercise and physical exertion beyond exhaustion and fati-gue. 1,2,4,5,6,8,11,12 For a collegiate soccer team that likely maintains a high level of physical fitness, what were the precipitating events?…”