High-voltage electrical injury of the upper limb with severe rhabdomyolysis, preserved early renal function, and favorable short-term recovery: a case report

High-voltage electrical injuries are uncommon but potentially limb- and life-threatening because the extent of deep tissue damage may be disproportionate to the visible cutaneous injury. Upper limb involvement is particularly important when the hand is affected and when acute motor impairment suggests underlying muscle and soft-tissue damage [1, 2]. A 24-year-old man with no relevant past medical history sustained a work-related high-voltage electrical injury after touching a high-voltage cable with his left hand while wearing a safety harness and rubber gloves. On presentation, he had a circumferential second-degree burn of the left shoulder and a third-degree burn of the volar left hand with tissue loss, associated with painful edema of the arm and forced flexion of the fingers and wrist with impaired extension. Initial laboratory testing showed leukocytosis, hypokalemia, mild acidemia, hypoxemia, and marked muscle injury with creatine kinase (CK) 9,705 U/L. Two further urgent samples during the following 24 hours documented worsening rhabdomyolysis, with CK rising to 13,247 U/L and then 25,959 U/L, accompanied by elevated aspartate aminotransferase and lactate dehydrogenase. One venous blood gas also showed severe hyperlactatemia (10.48 mmol/L) with lactic metabolic acidosis. Despite this, serum creatinine remained within the normal range throughout the hospital course. Electrocardiography showed sinus rhythm without acute ischemic or sustained arrhythmic abnormalities. The patient underwent urgent operative management, received perioperative cefazolin, tetanus prophylaxis, and intravenous fluids, and was admitted to intensive care for monitoring before transfer to a referral center. He subsequently required skin grafting and was discharged home after a hospital stay of more than two weeks. At follow-up within 1–3 months, functional recovery was complete or near complete, with no relevant long-term complications reported. This case highlights the dissociation that may occur between a localized external burn pattern and severe internal muscle injury after high-voltage electrical exposure. Serial laboratory monitoring was essential to identify severe rhabdomyolysis and transient lactic metabolic acidosis, while early renal function and ECG findings remained reassuring. Prompt multidisciplinary management, specialist transfer, and follow-up reconstructive care were associated with a favorable short-term outcome.