Superimposed cocaine-induced rhabdomyolysis in a patient with aortic dissection rhabdomyolysis.

A 52-year-old man presented with acute, sharp chest pain radiating to the back and abdomen after using cocaine 18 hours previously. Computed tomographic angiography revealed a type B aortic dissection that extended to the iliac arteries. The patient underwent balloon fenestration, placement of multiple aortic stents, and bilateral leg fasciotomy. He eventually went into hyperkalemic arrest but was successfully resuscitated, after which his serum lactate and creatine kinase levels peaked at 7.4 mmol/L and 990,400 U/L, respectively. The combination of aortic dissection and creatine kinase toxicity was extensive enough to cause permanent renal failure and paraplegia below T6. The severity of the patient's symptoms was attributed to concomitant cocaine-induced rhabdomyolysis and aortic dissection rhabdomyolysis.