I have a patient that presents as follows. 37 yo male caucasian, happily married. Lifted weights one day, became very fatigue and within 48 hours went into rhabdo. Was admitted to hospital, no permanent damage. They have not been able to find a cause. He has not gone into rhabdo again but he has had significant activity limitations such as SOB, easily fatigue and chest pain that is centered on the muscle on the left side of his heart. All labs are negative, ECG normal, ECHO normal, CXR normal, lung and cardiac exam normal. He has been worked up by Neurology, muscle biopsy normal. When I run my knuckles across his chest he develops a severe burning sensation that , increases in intensity for one minute before it starts to subside. Now its developing more frequent without provocation. And the feeling can be induce in his arm and legs, much much more milder. Any thoughts?
He doesn't sleep (4 hours a night, and has been like that for many years). Drinks 8 cups of coffee daily but has been off coffee for 2 weeks, only drinking decaf.