Rhabdomyolysis associated with mania in late life

Abstract

We report a case of rhabdomyolysis associated with acute mania in a 74 year old man. What makes this case noteworthy is the development of multiple episodes of rhabdomyolysis in the context of excessive physical exercise in an old man who was never diagnosed with a psychiatric illness. Rhabdomyolysis is a potentially fatal condition that follows skeletal muscle injury and can lead to serious complications such as renal failure (1) (2). Skeletal muscle injury, traumatic or non-traumatic, may trigger the release of intracellular contents including creatine phosphokinase (CPK) and myogobin which is manifested by elevated serum CPK and myoglobinuria (1) (2). The classic triad of rhabdomyolysis is muscle pain, weakness and dark urine (1) (2). In a study of 77 patients aged 21–85 years who developed rhabdomyolysis, 8 patients of unspecified age died (3). Delay in diagnosis and treatment of rhabdomyolysis may increase the risk of mortality (1) (2) therefore, early identification and intervention are crucial for a good outcome. The prevalence of rhabdomyolysis is unknown and considered rare, however, descriptions are confined mostly to case reports (1) (2). The incidence of rhabdomyolysis in psychiatric patients is not known (1). Nevertheless, several risk factors make psychiatric patients more vulnerable to develop rhabdomyolysis and these factors include catatonia, agitation, alcohol abuse, and neuroleptic medications (1) (2) (4) (5).