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Acute bilateral compartment syndrome of the thigh induced by exercise. A case report.

A twenty-seven-year-old man was seen in the emergency room with reddish-brown urine, cramping in the thighs, and fever. Twentyfour hours before, he had performed more than 200 squats after being challenged by a peer. Approximately six hours later, he noticed a change in the color of the urine. During the next twelve hours, he had progressively worsening pain in both thighs but especially on the right side. He had taken no medications recently and none after the exercisc. He did not exercise regularly, but he did engage in some kind of physical activity, such as golf, volleyball, or jogging, once or twice a month. He had no history of any bleeding disorder, hypertension, or other abnormality. The patient had a temperature of 37.4 degrees Celsius. Both thighs were very hard and extremely tender to palpation. The circumference of the right thigh was fifty-four centimeters and that of the left, fifty-one centimeters. There was decreased sensation to light touch on the lateral aspect of both thighs, but the remainder of the neurological examination revealed normal findings. The dorsalis pedis and posterior tibial pulses were strong bilaterally, and the skin was warm throughout the lower extremities and without cyanosis. The ranges of motion of the joints and the strength of the muscles of the lower extremities were difficult to assess because of pain. Initial laboratory studies showed a white blood-cell count of 16.2 x 10’ per liter (16,200 per cubic millimeter) with 82 per cent neutrophils, 2 per cent band forms, 8 per cent lymphocytes, and 8 per cent monocytes. The hemoglobin level was 10.6 millimoles per liter ( 17.1 grams per deciliter): the blood urea nitrogen level, 5.7 millimoles per liter (sixteen milligrams per deciliter): the creatinine level, seventy-six micromoles per liter (1.0 milligram per deciliter); the total bilirubin, forty-four millimoles per liter (2.6 milligrams per deciliter); the serum glutamic-pyruvic transaminase level, 392 units per liter; the serum glutamic-oxaloacetic transaminase level, 1990 units per liter: the creatine phosphokinase level, 1 16,460 units per liter; and the lactic dehydrogenase level, 4230 units per liter. In the initial urinalysis, the findings were a specific gravity of 1.022: pH, 6; protein, 3+; glucose, negative: ketone, trace; bilirubin, negative; and hemoglobin, 3+. A diagnosis of rhabdomyolysis was made in the emergency room. The patient was admitted for vigorous hydration to preserve renal