P6103 - Running into Trouble: A Case of Acute Liver Failure From Severe Rhabdomyolysis After a Marathon

Ivana Rubenstein, DO¹, Lorraine Chong Tai, MD¹, Edwin Makarevich, DO¹, Amanda Eukovich, DO¹, Andrea Escalante, DO²
1Broward Health Medical Center, Fort Lauderdale, FL; 2Broward Health Medical Center, Miami, FL

Introduction: Rhabdomyolysis-induced acute fulminant liver failure is a rare but life-threatening complication, often triggered by extreme physical exertion. We present the case of a healthy young adult who developed acute fulminant liver failure and renal failure following marathon-associated heat stroke and rhabdomyolysis, possibly exacerbated by Adderall use.

Case Description/

Methods: A 21-year-old male with a history of ADHD on Adderall presented with altered mental status during a marathon after reportedly ingesting Adderall mid-race. On arrival, he was encephalopathic, diaphoretic, hyperthermic, and subsequently intubated. Labs revealed severe rhabdomyolysis (CK >266,000), acute liver injury (AST 13,305, ALT 5,393), acute kidney injury (Cr 7.8), coagulopathy (INR 2.5, platelets 47), and elevated ammonia (156). Imaging showed hepatomegaly and signs of nonspecific enteritis. The patient was treated with N-acetylcysteine, hemodialysis, lactulose, and supportive ICU care. A liver biopsy revealed regenerative changes with mild fibrosis. Mental status improved, and he was successfully extubated. Despite initial deterioration (MELD-Na peaked at 32), the patient showed remarkable recovery with normalization of LFTs and improved renal function.

Discussion: This case highlights the synergistic toxicity of exertional heat stress, sympathomimetic use (Adderall), and rhabdomyolysis, culminating in acute multi-organ failure. Clinicians should maintain high suspicion for rhabdomyolysis-related acute liver failure in patients with exertional collapse, especially with stimulant use. While rhabdomyolysis is typically associated with renal complications, this case underscores its potential to precipitate acute liver failure. Prompt recognition, early ICU intervention, and multidisciplinary management can lead to full recovery even in fulminant presentations.


Figure: Figure 1: Pathology image showing hepatic fibrosis.

Disclosures:
Ivana Rubenstein indicated no relevant financial relationships.
Lorraine Chong Tai indicated no relevant financial relationships.
Edwin Makarevich indicated no relevant financial relationships.
Amanda Eukovich indicated no relevant financial relationships.
Andrea Escalante indicated no relevant financial relationships.

Ivana Rubenstein, DO¹, Lorraine Chong Tai, MD¹, Edwin Makarevich, DO¹, Amanda Eukovich, DO¹, Andrea Escalante, DO². P6103 - Running into Trouble: A Case of Acute Liver Failure From Severe Rhabdomyolysis After a Marathon, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.