Extraosseous uptake of Tc-99m HDP in muscular dystrophy

A 43-year-old woman with muscular dystrophy was admitted for sudden onset of rhabdomyolysis and myoglobinuria. Serum creatine phosphokinase levels peaked at 230,000 U/I. Her family history was positive for muscle carnitine palmityl transferase deficiency, with episodic myoglobinuria in a sister. The results of a workup for toxic, infectious, and inflammatory myopathic causes were negative. A whole-body bone scan was performed. Treatment consisted of bed rest and fluids, with resolution of her symptoms and abnormal laboratory findings within 3 weeks. Bizarre extraosseous uptake with bone scintigraphy has been documented in cases of rhabdomyolysis caused by drugs and strenuous activity.