Extensive rhabdomyolysis after streptokinase therapy for acute myocardial infarction demonstrated by Tc-99m PYP scintigraphy

A 76-year-old man with acute inferior myocardial infarction was treated with streptokinase. Two days later, severe rhabdomyolysis developed that was complicated by acute anuric renal failure that required dialysis. His peak serum creatinine kinase level was 85,000 u/I. Large areas of necrotic skin developed on his abdomen and lower limbs. Whole-body scintigraphy performed with 25 mCi Tc-99m PYP revealed extensive abnormal tracer uptake in the major muscle groups of the lower limbs, consistent with acute myocyte injury.