Cocaine-induced rhabdomyolysis and compartment syndrome

Abstract

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.

A Case of Daptomycin-Induced Rhabdomyolysis: A Life and Limb Threatening Complication

“…According to the American Addictions Center, cocaine can be detected in the urine anywhere from three days to two weeks [ 14 ]. As rhabdomyolysis is often the result of multiple factors, one could speculate that any recent cocaine use on top of the daptomycin infusion could have further contributed to the development of this complication [ 15 ].…”

Neurological Effects of Stimulants and Hallucinogens

“…72 If there is significant pain, pallor, paresthesias, or pulselessness of an extremity in this patient population, compartment syndrome secondary to rhabdomyolysis must be considered, which can be limb-threatening if not treated promptly. 73 The risk of rhabdomyolysis with amphetamines used to treat ADHD is less clear and is often in the context of other exposures and risk factors in the literature. 40,41 Multiple movement disorders have been described with psychostimulant use (►Table 2).…”

A 68-Year-Old Man with Depression and Acute Renal Failure Due to Rhabdomyolysis Associated with Alcohol Intoxication While Taking Low-Dose Escitalopram: A Case Report

“…Additionally, metabolic and endocrine disorders [5,15] such as hyperaldosteronism and hypothyroidism can also trigger this syndrome. Furthermore, a toxic etiology arising from medications like statins [16], antidepressants [17], and antivirals [18] is also well-documented, as are cases stemming from substance use disorders involving heroin, cocaine [19,20], and alcohol [4,21]. Cases have even been reported following prolonged periods of inactivity [22], such as in individuals who have fallen and remained immobile for an extended duration.…”