A 41 year old man presents with diffuse abdominal pain, generalized myalgia, and dark urine for 2 days. He did not experience dysuria, frequency or urgency.

There is no history of recent trauma, NSAID use, recreational drug abuse, or travel to a foreign country.

His medical history is significant for HIV infection for 2 years, for which he is on ritonavir-boosted atazanavir, tenofovir and emtricitabine. He was tested in this regard 1 week ago, and found have a CD4 count of 450 cells/mm3 with consistent viral suppression.

He was also diagnosed with dyslipidemia 1 month ago, and after poor control with diet alone, started on simvastatin 20 mg daily.

He does not smoke and only drinks socially. A full blood count is found to be normal.

Select Relevant Investigations
Serum CPK + Myoglobin


Serum Creatine Phosphokinase (CPK): 56,570 IU/l (normal: 5-100)
Serum Myoglobin: 21,600 mcg/L (< 90)
Serum Electrolytes


Sodium: 138 mEq/L (135-145)
Potassium: 5.6 mEq/L (3.5-5.0)
Phosphorous: 4.9 mg/dL (2.5 - 4.5)
Calcium: 8.1 mg/dL (8.5 - 10.3)
Renal Function Tests


Serum creatinine: 0.64 mg/dL (0.6-1.2)
Cytochrome P450 Activity Assay


The results will be available in a few days.

Select Relevant Management
IV Furosemide
Stop Simvastatin
Aggressive IV Fluid Therapy