The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 05; 11(1):e1-e1 

A Case of Rhabdomyolysis with Rigors 

Basil Akpunonu1*, E. Bliss1, S.D. Vellani1, C. Spencer1, D. Federman1, S. Khuder1 

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 

*Corresponding author: Basil.Akpunonu@utoledo.edu

Published: 05 May 2023 

Introduction: Rhabdomyolysis is a potential life- threatening condition caused by extensive skeletal 
muscle breakdown with leakage of toxic muscle contents into the circulation. The most dreaded 
complication is acute renal failure caused by toxic effects of myoglobin in the kidneys. The causes of 
rhabdomyolysis are classified into traumatic, non-traumatic exertional, and non-traumatic 
rhabdomyolysis. The pathophysiologic hallmark of rhabdomyolysis regardless of etiology is increased 
free ionized calcium due to cellular energy depletion (ATP) or direct plasma membrane rupture and 
consequent intensified muscle contractility, mitochondrial dysfunction, and production of oxygen 
radicals. 

Case Report: We report a case of a middle-aged black woman with rhabdomyolysis that was caused by 
intense shivering chills, and rigor from pneumonitis. She had no personal or family history of muscle 
disorder and was admitted to the hospital after a weeklong history of upper and lower respiratory 
symptoms that led to the worse shivering and shaking chills she ever had. She was noted to have 
elevated creatine phosphokinase (CPK) of 200,000 uL (26–192 uL) and creatinine level of 5.52 (0.81–
1.2 mg/dL). She was started on intravenous fluid with half-isotonic saline (0.45%) or 77 mmol/L 
sodium, 75 mmol/L sodium bicarbonate, and hemodialysis with progressive improvement in kidney 
function that took up to seven weeks to full recovery. 

Conclusion: Shivering and shaking chills from respiratory infection can cause rhabdomyolysis with 
severe muscle damage and renal failure in a patient with no known underlying muscular-skeletal 
disorder condition but has good recovery with fluid management and hemodialysis. Renal function has 
returned back to normal. 

https://dx.doi.org/10.46570/utjms.vol11-2023-671 

https://dx.doi.org/10.46570/utjms.vol11-2023-671
mailto:Basil.Akpunonu@utoledo.edu