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Education And Debate

Lesson of the Week: Acute swollen legs due to rhabdomyolysis: initial management as deep vein thrombosis may lead to acute renal failure

BMJ 1994; 309 doi: (Published 19 November 1994) Cite this as: BMJ 1994;309:1361
  1. R H Mallinson,
  2. D J A Goldsmith,
  3. R M Higgins,
  4. M C Venning,
  5. P Ackrill
  1. Artificial Kidney Unit, Withington Hospital, Manchester M20 8LR
  1. Correspondence to: Dr Goldsmith
  • Accepted 14 January 1994

Deep vein thrombosis is often diagnosed in patients who present with acutely swollen and painful calves. By contrast, rhabdomyolysis is a fairly rare condition that can easily be missed. It may be discovered only when the patient has established renal failure and the opportunity for preventive treatment has passed. We present the case history of a patient with bilateral calf swelling that was initially managed as deep vein thrombosis but was later found to be due to rhabdomyolysis. The initial management may have contributed to the development of acute renal failure and the need for dialysis.

* Rhabdomyolysis should be considered in the differential diagnosis of swollen legs. Mismanagement as deep vein thrombosis may lead to acute renal failure

Case report

A 44 year old man who had previously been well, apart from frequently misusing alcohol, was admitted to a neighbouring hospital's accident and emergency department after a particularly heavy bout of drinking, which had left him in a stuporous state. When he eventually woke up he could not walk; he had “pins and needles” in his legs, and his calves were swollen. Bilateral deep vein thrombosis was diagnosed and apparently confirmed by non-filling of deep veins …

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