A 24-year-old male patient presented to the emergency department with left-sided back pain and bilateral lower limb myalgia. The previous day, he was involved in a head-on motor-vehicle collision at 20 miles per hour after high-intensity training for 8 h for a bicycle race. He had no family history of hypouricemia. On physical examination, an absence of costovertebral tenderness indicated that the left-sided back pain was not from traffic trauma. Laboratory tests revealed elevated serum creatinine (2.68 mg/dL), creatine kinase (16,719 IU/L), direct bilirubin (4.1 mg/dL), and uric acid (12.2 mmol/L) levels.
