Our patient was a 29-year-old Srilankan male, with no known previous comorbidities. On October 31, 2018, he presented to the emergency department of Hamad General Hospital. He had a history of a heavy object falling on his back. He complained of severe back pain and the inability to move his lower limbs. He was able to move both of his upper limbs; however, the power of his lower limbs was 0/5. His sensations were intact, the anal tone was weak, the perianal sensation was intact, and bulbocavernosus reflex was+ve. A CT scan and MRI were performed and showed a burst fracture of the L2 vertebral body with retropulsion, which compromised the spinal canal, causing severe spinal cord injury.
On October 31, 2018, he underwent urgent tbl12-L4 transpedicular screw fixation and a tbl12 and L1 laminectomy. He was kept postoperatively in the trauma ICU for observation. A follow-up X-ray of his spine showed satisfactory alignment and placement of the screws.
The patient was reviewed by the rehabilitation physician, who agreed to move the patient to the Qatar Rehabilitation Institute for an active rehabilitation program.
On November 8, 2018, the patient was transferred from the neurosurgery ward to QRI.
The patient underwent rehabilitation by a multidisciplinary team in a spinal cord injury rehabilitation unit.
On admission to QRI, the patient was paraplegic ASIA B level L2. He had no power in both lower limbs but had intact sensations. He was dependent for activities of daily living with a functional independence measure (FIM) score of 69/126. 
He was on gabapentin 300 mg, three times a day, for neuropathic pain in his lower limbs. He was also taking dalteparin sodium, senna, and a multivitamin. His pain score was a numeric rating score (NRS) 6/10. His pain was not relieved but was increasing. On November 13, 2018 (day 13 postinjury), the dose of gabapentin was increased to 600 mg, three times a day. On the next day, (day 14 postinjury), he complained of increased lower limb and whole-body pain of NRS 8/10. On examination, he had severe muscle tenderness throughout his whole body, including his upper and lower limbs (NRS 9-10/10). He was observed for a few days presuming that the pain was due to exercise and the preexisting pain. When his pain had not improved, an internal medicine consultation was performed. A blood workup was sent on suspicion of myositis on 5th December 2019 and returned with the following results: serum creatine kinase (CK) was high- 747 U/L (reference range, 39-308 U/L), myoglobin was high- 152 ng/ml (reference range, 28-72 ng/ml), C-reactive protein(CRP) was high- 22.9 mg/L (reference range, 0-5 mg/L), ALT was high- 75 U/L (reference range, 0-41 U/L), AST was high- 46 U/L (reference range, 0-40 U/L), and the creatinine level was normal. Unfortunately, his CK and myoglobin levels before the increase of gabapentin dose were not available.
A diagnosis of gabapentin-induced myositis was made from the background of blood investigations (increase CK and myoglobin), clinical profile (new-onset generalized muscle pain and tenderness), and Adverse Drug Reaction Probability Scale (Naranjo algorithm) score of 6 of gabapentin. The Naranjo algorithm score of 6 indicated that gabapentin is the probable cause of myositis. Other medications- senna, dalteparin sodium, and the multivitamin were excluded as causes of myositis by their negative Naranjo algorithm scores (senna -2, dalteparin sodium -2, and multivitamin -2). On December 12, 2018 (day 42 postinjury), gabapentin was discontinued. His severe muscle pain of the whole body reduced dramatically in the next three days after discontinuation of the gabapentin. His follow-up blood workup on December 19, 2018 (day 49 postinjury) showed a CK of 203 U/L (previously 747 459 U/L) and myoglobin 90 ng/ml (previously 152 ng/ml). After discontinuation of gabapentin, his pain was managed effectively with paracetamol 1000 mg, when necessary, three times daily (if pain NRS 4/10 or more).
On January 16, 2019 (day 77 postinjury), the patient was discharged from QRI. On discharge, the patient was ASIA C level L2. He was on selfintermittent catheterization and was wheelchair bound (self-propelled) for indoor and outdoor mobility. His FIM score was 111/126 (FIM on admission to QRI: 69/126). There were no adverse effects after discontinuing gabapentin. He was followed up in an outpatient rehabilitation program. Table 1 describes the timeline of important clinical developments of the case.