Spontaneous Bilateral Rectus Abdominis Rhabdomyolysis in a 24-Year Old Male Following Intense Physical Activity in a Sub-Urban Nigerian Town: A Case Report

Abstract

Introduction: Exercise induced Rhabdomyolysis is a syndrome characterised by disintegration of the skeletal muscles and release of toxic intracellular contents into the plasma. It can be precipitated by strenuous exercise and its diagnosis can easily be missed by physicians. Soft tissue ultrasonography is an invaluable tool for evaluating patients with rhabdomyolysis especially in sub Saharan Africa where sophisticated imaging modalities like magnetic resonance imaging (MRI) and computed tomographic scanners are not readily available. Ultrasonography in this case is the commonly available modality. It is cheap and easier to use. It can aid in the diagnosis of suspected cases, help to determine extent of the disease, identify associated complications and also for monitoring disease progression. Spontaneous rhabdomyolysis following exercise has not been previously reported in our environment. Objectives: To report a case of exercise induced rhabdomyolysis in a 24 year old male patient. To highlight the importance of ultrasound in evaluating patients with rhabdomyolysis, describe the notable ultrasound findings and review relevant existing literature on this condition. Case Report: A 24 year old male with spontaneous rhabdomyolysis of the infra-umbilical segment of both recti abdominis muscles, who presented to a private ultrasound facility in Agbor, Delta state, Nigeria. His symptoms were; lower abdominal pain made worse with movements, and passage of dark red urine which developed spontaneously following a week history of intense physical exercise at a gymnasium. An ultrasound scanner of the Toshiba Medical systems Corp Model 2016 (Xario 100) with a 7 to 12 MHz linear array transducer was used to scan both recti abdominis muscles in different planes. Abnormal findings were noted involving the infra umbilical segment of both abdominal recti muscle belly. Notable findings were thickening of the muscle fascia, blurring of the fat planes, fat stranding, disorganization of the normal architectural pattern of the fibres as well as presence of hypoechoic lesions within the affected muscle segment. The images were frozen and the sonograms were acquired and saved. Conclusion: Ultrasonography is an indispensable tool for evaluating patients with exercise induced spontaneous rhabdomyolysis. This case study is of immense significance in developing affordable methods of image based diagnosis and investigation of rhabdomyolysis that also aids in standard clinical, laboratory and histopathological studies of the condition.