Rhabdomyolysis in a Recreational Swimmer - Case Report - Singapore Med J 2012 53(2) e42

Oct 2, 2026

Rhabdomyolysis is a clinical and biochemical syndrome caused by skeletal muscle injury that can lead to acute renal failure and death. Exertional rhabdomyolysis usually follows strenuous eccentric exercise in hot, humid conditions and is often reported among marathoners and military personnel. A case study presents a 32-year-old Malaysian man with rhabdomyolysis and myoglobinuria without acute renal failure after two episodes of unaccustomed swimming, treated conservatively with an uncomplicated recovery and a brief discussion of pathophysiology, management principles, and recuperation.

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Introduction

Case Report

Discussion

C ase R eport Singapore Med J 2012; 53(2) : e42 Rhabdomyolysis in a recreational swimmer Stella JJ1, MBBS, Shariff AH1, MBBS, MMed | ABSTRACT Rhabdomyolysis is a clinical and biochemical syndrome resulting from skeletal muscle injury, which may ultimately lead to acute renal failure (ARF) and death. Exertional rhabdomyolysis refers to skeletal muscle injury that is usually induced by strenuous eccentric exercises in a hot and humid environment. It is usually seen in marathoners and military personnel. We present the case of a 32-year-old Malaysian man who had rhabdomyolysis and myoglobinuria without ARF after two episodes of unaccustomed swimming. He was treated conservatively, and recovered uneventfully. A brief discussion on the pathophysiology of rhabdomyolysis, the principles of management and recuperation is included. | | | --- | --- | | Keywords: athletic injuries, case management, myoglobinuria, pathophysiology, rhabdomyolysis Singapore Med J 2012; 53(2): e42–e44 | | | INTRODUCTION
Rhabdomyolysis is defined as a clinical and biochemical syndrome resulting from skeletal muscle injury that sufficiently disturbs the integrity of sarcolemma to allow the release of muscle cell content into the plasma. Epidemiologically, it is often underreported; as many as 26,000 cases may occur per year.(1)
Exertional rhabdomyolysis refers to skeletal muscle damage induced by exercise, especially strenuous and eccentric exercises. A search in the iMalaysiana and the Singapore Medical Journal did not yield any result on exertional rhabdomyolysis. This report describes the case of a recreational swimmer who presented with rhabdomyolysis.
CASE REPORT
A 32-year-old Malaysian Indian man presented to the Emergency Department with complaints of sudden onset of shortness of breath, headache, dizziness and generalised body aches that occurred while he was swimming several hours earlier. This was the second such episode; the first having occurred about a month ago, when he began to swim after not doing so for several years. In both incidents, the patient had been asymptomatic and well prior to swimming; his difficulties became apparent only after he had swum several laps in the standard swimming pool of the hotel where he worked. He did not seek treatment for the first incident.
The patient had no significant medical history except for an undiagnosed headache often years duration, which was unrelated to physical activity. He had been working as a hotel receptionist for six years, and had recently doubled up as a lifeguard at the same hotel. He worked out at the hotel gym thrice weekly, focusing mainly on aerobic endurance exercises with varying intensities, with occasional strength training. He was able to exercise without much distress or body ache.
He neither smoked nor consumed alcohol or other substances. He was also not on any alternative or traditional remedy. | He had no family history of neuromuscular disease; however, both his parents had diabetes and hypertension.
Physical examination revealed the patient to be a mediumbuilt man who was alert and able to walk into the Consultation Room unaided. His vital signs were stable, but he was slightly tachycardic. He had a blood pressure of 124/82 mmHg, heart rate 116 beats per minute, respiratory rate 20 per minute, pulse saturation 98% at room air, and was afebrile. Musculoskeletal examination revealed generalised muscle tenderness, which was more prominent on the proximal upper body region (bilateral pectoralis, deltoid, biceps, triceps) . However, muscle power was preserved and he had no neurological deficit. The patient had normal joint movements but experienced some difficulty in squatting due to the pain in his lower limbs. The rest ofthe physical examination was normal.
Laboratory examination revealed elevated serum creatine kinase (CK) level of 112,400 U/L (normal range [NR]: 35–230 U/L), with CK-MB of 980 U/L (NR: 0–12 U/L) . Renal function and electrolyte

FAQs

What defines rhabdomyolysis in this report?

Rhabdomyolysis is defined as a clinical and biochemical syndrome from skeletal muscle injury that disrupts the sarcolemma, allowing muscle cell contents to enter plasma.

What symptoms and circumstances preceded the patient’s rhabdomyolysis?

A 32-year-old Malaysian man developed sudden shortness of breath, headache, dizziness, and generalized body aches while swimming, after resuming swimming following a period of not swimming for several years.

How was the patient treated and what was the outcome?

The patient received conservative management with total rest at home. Follow-up showed decreasing symptoms and laboratory markers, and he was discharged once urine findings and assessments were almost normal.

Oct 2, 2026

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