Rhabdomyolysis following violent behavior and coma

Area of Science:

• Toxicology
• Nephrology
• Neurology

Background:

• Phencyclidine (PCP) is a dissociative drug known for its potential to induce psychosis and violent behavior.
• Rhabdomyolysis, the breakdown of muscle tissue, can lead to serious complications such as renal failure.

Observation:

• A patient presenting with acute psychotic and violent behavior, suspected to be under the influence of PCP, experienced cardiac arrest, coma, and renal failure.
• Muscle biopsy revealed rhabdomyolysis, and kidney sections showed myoglobin casts.
• Extensive toxicology screens for PCP, cocaine, and other narcotics were negative.

Findings:

• The negative toxicology results precluded a definitive correlation between PCP and the observed rhabdomyolysis and acute psychotic episode.
• The case highlights the potential for severe systemic effects in individuals exhibiting PCP-like symptoms, irrespective of confirmed drug presence.

Implications:

• This case underscores the importance of considering severe rhabdomyolysis and its systemic consequences in patients with acute psychosis and violent behavior, even with inconclusive toxicology.
• Further research into the complex interplay between certain behaviors, potential drug influences, and severe medical outcomes like rhabdomyolysis is warranted.
• Understanding the etiology and pathogenesis of rhabdomyolysis remains crucial for clinical management and patient outcomes.