Peripheral nerve damage in patients with nontraumatic rhabdomyolysis

Four patients with rhabdomyolysis due to drug intoxication were found to have peripheral nerve damage. Three patients were comatose and one was lethargic. The diagnosis of rhabdomyolysis was made by marked elevation in blood levels of creatine phosphokinase and strongly positive orthotoluidine test without RBCs in the urine. Acute renal failure developed in three patients and one had mild renal insufficiency. Electromyography showed damage to the brachial plexus in three of the patients and there was involvement of the musculocutaneous, radial, ulnar, and peroneal nerves in the fourth patient. The neurologic abnormalities disappeared completely within six weeks in two patients and considerably improved within four weeks in another patient after discharge from the hospital.