Cocaine-induced rhabdomyolysis and compartment syndrome.

Mian Harris Iftikhar, Aneeqa Yousaf Dar, Alexandra Haw

BMJ case reports 2022 May 19

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A man in his 30s with a history of cocaine and intranasal heroin use presented to the emergency department with severe leg pain and weakness. Physical examination findings were significant for tachycardia, absence of dorsalis pedis pulses, tense and painful calf muscles along with absence of plantar reflexes in bilateral lower extremities. Laboratory investigations were significant for positive urinary drug screen for cocaine, severe rhabdomyolysis and acute kidney injury. Given the absence of dorsalis pedis pulses in bilateral lower extremities and radiological evidence of oedematous changes in calf muscles with perimuscular oedema, a diagnosis of compartment syndrome was made. He was treated with bilateral lower extremity four-compartment fasciotomies and haemodialysis for acute kidney injury. Rhabdomyolysis has been attributed to cocaine use; however, compartment syndrome is a very rare complication, especially in the absence of trauma or prolonged immobilisation. © BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Citation

Mian Harris Iftikhar, Aneeqa Yousaf Dar, Alexandra Haw. Cocaine-induced rhabdomyolysis and compartment syndrome. BMJ case reports. 2022 May 19;15(5)