She also had the highest CRP I have ever seen, 147.
The etiology you ask? She presented three days after a sore throat. We initially discounted viral rhabdo because the CPKs were so high but the Coxsackie B type 3 and 4 antibodies were off the scale and the literature is sprinkled with similar case reports (here and here). Muscle biopsy results are pending.
Muddy brown cast (day one, unspun specimen):
Still can't believe I didn't get a picture of the urine on the first day, it was black.
.@kidney_boy re:CPK I see Phos was never uncontrolled - anything to say about Ca both at presentation & during alkalinisation? #nephrology
— Tom Oates (@toates_19) June 4, 2013