Olanzapine-induced acute rhabdomyolysis - A case report

A 29-year-old white man with first diagnosis of acute paranoid schizophrenia received for the first time a neuroleptic medication. On admission, creatine phosphokinase (CK) was within normal range (86 U/l). Two days after initiation of treatment with olanzapine (10 mg per day), the patient complaint about mild muscle jerks, and elevated serum CK (949 U/l) was found. One day later, serum CK raised within hours from 9250 U/l up to 34 503 U/l peak concentration. There was no clinical evidence of a neuroleptic malignant syndrome (NMS) or other muscle diseases. After stopping drug treatment and forced diuresis serum CK returned to normal levels within two weeks without acute renal failure. The case report points to necessity of monitoring serum CK during olanzapine treatment when mild muscular symptoms occur.