Exercise-Induced Severe Rhabdomyolysis in G6PD Deficiency Presented with Heat Stroke: A Case Report

Abstract

BACKGROUND The prevalence of glucose-6-phosphate deficiency in Malaysian female population is 1.05%. Al- though triggers for haemolysis are well documented, ex- ercised induced crises have been described. We report a 26-year-old female army officer who presented with loss of consciousness and severe dehydration after 4 con- secutive days of the high-intensity sport. At presentation, she was hypotensive and had a high-grade fever. Blood investigations revealed acute kidney injury, elevated cre- atinine kinase of more than 100,000 U/L, anaemia, hyper- bilirubinemia with raised lactate dehydrogenase sugges- tive of haemolysis. On further questioning, she had G6PD deficiency. Literature review on exercise-induced oxida- tive stress to the skeletal muscle is presented. Probable mechanisms of cellular injury in rhabdomyolysis related to G6PD deficiency are also discussed. Unrecognized G6PD deficiencyamongarmypersonnelposedbothhealthcon- cerns to the patient and military service.