Paraspinal Rhabdomyolysis: A Rare but Essential Diagnosis With a Back Pain Bounceback

Paraspinal rhabdomyolysis is a rare but important diagnosis in the emergency department (ED). Diagnosis is challenging due to the difficulty in identifying cardinal signs of "pain out of proportion" on exam that differ from the common complaint of muscular back pain. Moreover, exertional rhabdomyolysis is less common than drug- or heat-induced rhabdomyolysis, and these patients are often young, male, endurance athletes. This report adds to the literature with a case of exertional paraspinal rhabdomyolysis in an overweight woman, not exposed to heat or medications predisposing to rhabdomyolysis, and whose pain was initially responsive to trigger point injections. A 38-year-old woman with a past medical history of polycystic ovary syndrome presented to the ED with low back pain, having presented the previous day with the same symptoms after completing an intense physical workout four days prior to initial presentation. Due to presumed musculoskeletal soreness/spasm as the etiology of her symptoms, she was again treated with trigger point injections and over-the-counter analgesia with moderate improvement in her pain, consistent with her course the previous day. Further evaluation was indicated given the patient's repeat presentation, which demonstrated paraspinal rhabdomyolysis without findings concerning for compartment syndrome. The patient was treated with IV fluids and admitted for management in line with general consensus treatment. Her symptoms improved and she was discharged on hospital day 2. Paraspinal exertional rhabdomyolysis is rare, but should be considered in patients presenting with low back pain after increased activity that is not responsive to conservative management.