Short-term high-dose steroid therapy in a case of rhabdomyolysis refractory to intravenous fluids

Objective: Unusual or unexpected effect of treatment Background: Rhabdomyolysis is a syndrome characterized by skeletal muscle breakdown, that involves the release of intracellular contents into the circulation, including creatine kinase (CK), myoglobin, electrolytes, organic acids, and purines. Causes of rhabdomyolysis include trauma, exertion, drugs, and toxins (including alcohol), and electrolyte abnormalities. The treatment of rhabdomyolysis is to remove the cause and use intravenous (IV) fluids. When this treatment strategy fails to work, high-dose IV steroids may be used. Case Report: We present a case of rhabdomyolysis following the use of 3,4-methylenedioxy-methamphetamine (MDMA) or ‘ecstasy’ with hypophosphatemia, which was found to be refractory to intravenous hydration. In this case, pulsed dosing of steroid therapy was found to be effective. Conclusions: Rhabdomyolysis that is refractory to treatment with IV fluids may respond to a short-term, high-dose course of IV steroids.