A 65-year-old woman with a background of paranoid schizophrenia presented to hospital with generalised muscle aches and weakness. She was diagnosed with schizophrenia 2 years prior following an acute psychotic episode and was initiated on olanzapine 10 mg (once nightly). She was fully compliant with treatment and not prescribed any other medications.

On admission, she was afebrile with a normal blood pressure and oxygen saturations on room air. Initial assessment demonstrated reduced power (4/5) and muscle tenderness bilaterally in her deltoids and quadriceps, and she was passing minimal amounts of dark urine.

Blood tests demonstrated a markedly raised creatine kinase (27 769 units/L), raised troponin-I (24 002 ng/L) and severe acute kidney injury …