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Fatal Rhabdomyolysis with Bilateral Gluteal, Thigh, and Leg Compartment Syndrome after the Army Physical Fitness Test

Acute exertional rhabdomyolysis is a clinically variable syndrome resulting from the lysis of skeletal muscle cells and the release of myoglobin and other cellular components into the circulation. The classic description by Knochel is that of a patient who has confusion, pallor, and hyperthermia, followed by renal failure, hyperkalemia, and disseminated intravascular coagulation. Relatively recent reports suggest that this entity may be more common than previously appreciated, and that it is not always accompanied by hyperthermia and renal failure. In addition, rhabdomyolysis may be associated with severe metabolic disturbances and compartment syndrome. Multiple causes of rhabdomyolysis have been identified, including crush injury and direct compression. Compartment syndrome of the thigh after exercise is considered an extremely rare condition. The first case of exercise-induced acute compartment syndrome of the thigh was reported by Kahan et al. in 1994. Gluteal compartment syndrome is even less common, and to our knowledge, exercise-induced gluteal compartment syndrome has not been previously described in the literature. This report illustrates a fatal case of acute exertional rhabdomyolysis complicated by multisystem organ failure, and bilateral leg, thigh, and gluteal compartment syndromes.