A 40-year-old man presented with decreased mental ability and acute renal failure. He had played computer games for 3 days without rest and proper oral intake before coming to our hospital. On admission, serum creatinine was 10.1 mg/dl. Urinalysis showed dysmorphic red blood cell (16-20/HPF) and proteinuria. Serum creatinine kinase was 13 840 U/l (normal range, 5-217) and serum myoglobin was 8621 ng/ml (normal range, 12-80). Other serological tests were all negative. Tc-99m MDP bone

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... (Figure 1 ) showed mainly increased uptake on both shoulder and upper arms. Other minor increased uptake was noted on neck, inner thigh and leg muscle. These were relatively symmetrical findings. He was treated with intravenous hydration and forced diuresis; over the following several days, creatinine was 1.4 mg/dl and urinalysis was normalized.