Rhabdomyolysis as the first manifestation of human immunodeficiency virus infection

Renal tubular acidosis (RTA) is a known complication of anti-retroviral medications. The presence of RTA in treatment naive-HIV patients is rare. A 49-year-old Caucasian woman presented with recurrent non-anion gap metabolic acidosis, AKI, rhabdomyolysis and hypokalemia on several occasions. Diagnosis of acquired distal RTA due to HIV was made given the history and laboratory data. To the best of our knowledge, this is the first case of HIV diagnosed with an initial presentation of rhabdomyolysis. We believe that acute renal failure was due to hypokalemia precipitating rhabdomyolysis caused by HIV-induced dRTA which was further exacerbated by amphetamine use.