Severe Rhabdomyolysis Presenting in Multisystem Organ Failure in an Adolescent With SC Trait

Tuesday, March 24, 2026

8:45 AM - 9:45 AM Central Time

Location: Connections Central - RST 15

TM

Travis Matics, DO (he/him/his)

null
Advocate Children's Hospital, Illinois

Disclosure(s): No relevant financial relationship(s) to disclose.
EG

Enzo Garcia, MD

Pediatric critical care attending
Advocate Children's Hospital, Illinois

Disclosure information not submitted.
MP

Molly Phillips, DO

Pediatric critical care attending
Advocate Children's Hospital, Illinois

Disclosure information not submitted.
EC

Enrique Cifeuntes, MD

Pediatric critical care attending
Advocate Children's Hospital

Disclosure information not submitted.
RK

Ronald Kampanatkosol, DO

Medical director, Pediatric intensive care unit
Advocate Children's Hospital

Disclosure information not submitted.
SP

Sofia Padilla, MD

Pediatric critical care attending
Advocate Children's Hospital

Disclosure information not submitted.
IA

Issa Alhamoud, MD

Pediatric nephrologist
Advocate Children's Hospital, Illinois

Disclosure information not submitted.
LS

Lauren Shaughnessy, PNP-AC

Pediatric critical care NP
Advocate Children's Hospital, Illinois

Disclosure information not submitted.
DW

Diane Ward, RN, BSN

Lead, Pediatric Pulmonary HTN nurse
Advocate Children's Heart Institute, Indiana

Disclosure information not submitted.
KN

Kristen Nelson McMillan, MD

Disclosure(s): No relevant financial relationship(s) to disclose.

Introduction: Rhabdomyolysis in pediatric patients can be life-threatening, often presenting with acute kidney injury (AKI), and may progress to multisystem organ failure (MSOF). Diagnosis can be challenging, but prompt recognition and initiation of therapies to treat consequences of muscle degradation is key to recovery. Etiologies in pediatrics include viral infection, strenuous exercise, status epilepticus, hemoglobinopathies and metabolic disorders. We present a case of an adolescent presenting with shock due to severe rhabdomyolysis.

Description: A 17-year-old male presented in shock after syncope while running track. He reported abdominal and leg pain for 3 weeks prior to presentation. He was in acute renal failure with severe metabolic acidosis and hyperkalemia requiring fluid resuscitation and renal replacement therapy (RRT). He developed compartment syndrome of the right thigh requiring emergent fasciotomy. Dramatically elevated creatinine phosphokinase (CPK) levels and MRI revealing diffuse active myositis of his abdominal musculature confirmed severe rhabdomyolysis. Hemoglobin electrophoresis revealed sickle cell trait. Microbiological studies were negative. High dose methylprednisolone was initiated. Subsequently during hospitalization, he suffered acute hypoxic respiratory failure secondary to pulmonary embolism, requiring venoarterial ECMO for 4 days. While recovering from his MSOF, mobility and neurocognitive function remained delayed, requiring inpatient rehabilitation. Seven months after initial presentation he had complete recovery of pulmonary and cognitive function. His renal function recovered, with secondary hypertension managed with losartan and amlodipine. Mild spasticity in his lower extremities is managed with oral baclofen, and he has full use of all muscle groups. He has not had any recurrence of rhabdomyolysis to date.

Discussion: Pediatric rhabdomyolysis is rare, requiring a high index of suspicion, as the triad of myalgia, muscle weakness, and tea-colored urine is only present in approximately 10% of patients. Consideration of this diagnosis in pediatric patients presenting with AKI, particularly in the presence of associated conditions discussed above, including sickle cell trait, may lead to earlier recognition and prevention of MSOF.