Case Challenge: Collapse and Muscle Pain in a 22-Year-Old Football Player
Case Challenge :
Collapse and Muscle Pain in a 22-Year-Old Football Player
Source: Medscape authors-Faizah Siddique, MD
,October 18, 2025
Keynotes:
1. Case Overview:
A 22-year-old college football player collapsed after sprinting drills in hot, humid weather (90°F, 85% humidity). He reported muscle pain, weakness, dizziness, and confusion.
2. Event Details:
The collapse occurred about 45 minutes before arriving at the ER. He was performing repeated 50-yard sprints, sweating heavily, and likely dehydrated.
3. Medical History:
Generally healthy; only prior injury was a left ankle sprain. No drugs or supplements. Drinks alcohol socially. Family history of diabetes and hypertension.
4. Physical Exam:
• Temp 99.5°F, BP 116/74 mmHg, HR 110 bpm
• Muscular but obese (113 kg, 1.88 m)
• Muscles tender and “doughy,” proximal weakness (4/5 strength)
• Neurologic exam normal, no focal deficits.
5. Lab Findings:
• CK = 12,976 IU/L (↑↑; normal 20–200)
• Creatinine = 1.7 mg/dL (slightly high → renal stress)
• Urinalysis: positive for blood but no RBCs → myoglobinuria
• Electrolytes and calcium normal; WBC mildly elevated (11,200 /μL).
6. Probable Diagnosis:
Exertional rhabdomyolysis — muscle breakdown due to intense exercise in heat, leading to myoglobin release and risk of acute kidney injury.
7. Key Learning Points:
• Recognize early signs of heat- and exercise-induced muscle injury.
• CK > 10,000 IU/L + dark urine without RBCs strongly suggests rhabdomyolysis.
• Prompt hydration and renal monitoring are essential to prevent kidney failure.
