Pulse Steroid Therapy in a Patient With Refractory Rhabdomyolysis of Unknown Etiology: A Case Report

Rhabdomyolysis is conventionally treated with aggressive fluid resuscitation and elimination of the inciting factor, whereas corticosteroids are typically limited to cases of immune-mediated myopathy. We describe an 18-year-old female who developed profound bilateral lower-limb swelling, bullae formation, and motor weakness following a viral prodrome. Laboratory evaluation revealed creatine phosphokinase exceeding 2000 IU/L (estimated by the laboratory staff to be ≈ 12,000 IU/L) and marked transaminitis with preserved renal function. Despite intensive hydration and low-dose corticosteroids, clinical and biochemical progression persisted, and extensive diagnostic workup remained negative. On hospital Day 9, intravenous methylprednisolone 500 mg daily was administered for three consecutive days. This was followed by rapid resolution of symptoms, normalization of muscle enzymes, and complete functional recovery by 3 months. The case suggests that early pulse corticosteroid therapy may avert irreversible muscle damage in selected patients with refractory rhabdomyolysis exhibiting inflammatory characteristics.