Had our awareness of this problem not been increased by the first case the diagnosis in the second case might well have been delayed. This is an important diagnosis to consider as rhabdomyolysis can lead to acute renal failure associated with myoglobinuria.2 In both patients adequate hydration was maintained, and neither developed myoglobinuria even though the creatine kinase concentration in the patient of normal build reached a peak of 20 000 IUll. In the light of our experience we now consider misuse of anabolic steroids as part of our differential diagnosis for atypical chest pain in all young people, not just those with an extremely muscular build.
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