We report the first cases, to our knowledge, of rhabdomyolysis due to extreme tic fits in two distinct patients with Tourette syndrome (TS).  These potential rare complications highlight the importance of appropriate tic and comorbidity management.

Tourette syndrome is a condition wherein motor and vocal tics occur, provoked by an urge but often not able to be completely voluntarily controlled.  Tics are known to cause physical and emotional risks to quality of life.  Although many patients respond, at least partially, to behavioral and pharmacologic interventions, some cases remain treatment-refractory and severely disabling.  Severe tics have been reported to cause self-injury, hospitalizations, and in extreme cases, permanent complications such as cervical myelopathy and eye enucleation. Rhabdomyolysis is a syndrome characterized by muscle necrosis, myalgias, and elevated creatine kinase (CK), which we report can be associated with severe tics.

Two patients with TS individually presented with extremely severe, continuous and intense tics leading to significantly elevated CK and diagnosis of rhabdomyolysis requiring hospitalization and intravenous fluids. A 12-year-old boy with dramatic truncal jerking and limb thrusting tics had recurrent admissions for fits of tics leading to rhabdomyolysis, CK as high as 6,953 U/L (normal <200 U/L), improving with IV fluids and medications to reduce tics. Separately, a 16-year-old boy was encountered with thrashing and self-punching tics, CK 2,682 U/L. Neither had neuroleptic malignant syndrome or other confounding metabolic, toxic or infectious causes for elevated CK. Both patients’ CK values normalized with treatment and improvement of tic severity and frequency. One patient was on concurrent neuroleptic therapy; his laboratory parameters improved when tics subsided despite continued neuroleptic use.

Our cases highlight the potential complication of rhabdomyolysis secondary to severe tic fits. Clinicians should recognize that rhabdomyolysis could be a complication of unchecked fits of tic-related movements.