Anything can happen....take a look

[DRISX]

That's a very common issue on all cummins isx engines , main cause is low RPM operation under high load in wrong gear . I have seeing 2 million mile ISX engines without a rebuild and still running strong , new ISX cm2250 and newer use small inducer and large exhaust side , making the low RPM operation a lot easier on the engine , in translation it does not choke up the engine because the turbo spools it up much faster . I have seeing guys snap rods , and in some occasions bend a crankshaft.

To avoid this keep the RPM's above 1350 under heavy load and under 1650 , much of it depends on truck set up , sometimes diffs play major role, not every truck was built to same spec.