Exertional Rhabdomyolysis, Hyposthenuria, and Acute Kidney Injury: The Non-benign Side of Sickle Cell Trait

Sickle cell trait (SCT) is largely understood to be a clinically silent disease that typically does not require intensive clinical monitoring or counseling of patients. In fact, many patients with SCT are unaware that they have this genetic condition. However, emerging studies, case reports, and reviews increasingly demonstrate that severe clinical pathology can be associated with SCT, showcasing the need for improved counseling and education. We present the case of a healthy young male patient who was admitted to the hospital with rhabdomyolysis, acute liver injury, extreme electrolyte disturbances, and acute renal failure necessitating emergent hemodialysis. Given that this was an otherwise healthy young athlete with no known risk factors, the gravity of his clinical condition led our team to question why he had such a severe presentation. Further evaluation revealed the diagnosis of SCT. SCT has been linked to an increased risk of exertional rhabdomyolysis, which causes muscle damage via microvascular occlusion as well as tissue ischemia, caused by endothelial damage. These processes predispose to a decreased ability to concentrate urine, increasing risk for dehydration, and more serious clinical presentations. The potential links between SCT and exertional rhabdomyolysis support the hypothesis that SCT is not a clinically silent condition.