Rhabdomyolysis and acute renal failure in sickle cell anaemia.

A 25 year old Nigerian man presented with a three day history of a painful right knee, abdominal pain, diarrhoea, vomiting, and fever. Previously healthy, he had been admitted to hospital only once before suffering from sickle cell crisis. Examination showed he was drowsy but well orientated. His temperature was 38 5-C and he was moderately dehydrated with a blood pressure of 110/70 mm Hg, both erect and supine. The heart and lungs were normal. There was some upper abdominal tenderness on the right side but no signs of peritonism and normal bowel sounds. The right knee was clinically normal and there were no focal neurological signs. Haemoglobin was 6-4 g/dl, white cell count 11-3x 10'/l with 920,, neutrophils. Radiographs of the chest, abdomen, and right knee showed no abnormality. Sickle cell crisis with possible biliary and bone sepsis was diagnosed, and he was given intravenous rehydration, penicillin, gentamicin, and analgesia. Six hours later his condition had deteriorated with persistent fever, confusion, and tachypnoea. There was pronounced right upper abdominal tenderness with reduced bowel sounds and signs of peritonism.