Interplay of Diet, Supplementation and COVID-19 in a Case of CPT-II-Related Rhabdomyolysis

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

American Journal of Kidney Diseases

Abstract

Carnitine palmitoyltransferase II (CPT-II) deficiency is the most common inherited disorder of long-chain fatty acid oxidation (LC-FAO). The myopathic subtype presents in adolescence or adulthood as episodic rhabdomyolysis from accumulation of toxic acyl-CoA intermediates due to impaired mitochondrial LC-FAO. Triggers for these episodes are typically intense exercise, fasting, medications, or infection. With only roughly 300 cases reported, this subtype is still a common cause of nontraumatic rhabdomyolysis. A 56-year-old male with a history of myopathic CPT-II deficiency presented to the emergency department for myalgia, weight loss, and foamy urine for a week. He denies any recent fasting, exercise, or trauma. He reported noncompliance with his medium chain triglyceride (MCT) supplement while adjusting his diet, noting a 10-pound weight loss in one week after increasing smoothies and vegetables and reducing meat. The patient had also tested positive with COVID-19 eleven days prior. Initial creatinine phosphokinase was 8450 U/L, peaking at 51,623 U/L two days after arrival. He was given IV hydration and analgesic medications. With supportive care alone, the patient did not require organ support. The patient was educated on continuing a low fat diet with MCT supplementation adherence and to avoid fasting or intense exercise. Outpatient follow up one week later showed return to baseline. This case focuses on the unique vulnerability CPT-II deficient patients have with small lifestyle changes. Although the ideal diet is debated, low-fat diets are generally advised, with ongoing discussion about the optimal protein-to-carbohydrate ratio. The literature is also unclear about how the patient’s one-week rapid weight loss may have influenced his presentation. Here a modifiable risk, medication compliance and sudden diet changes, and a nonmodifiable risk, COVID-19 infection, induced metabolic stress. To our knowledge, there is one report of CPT-II induced rhabdomyolysis after COVID-19 infection. A 56-year-old man with myopathic CPT-II deficiency developed rhabdomyolysis after stopping MCT supplements, compounded by dietary changes and recent COVID-19.

Volume

87

Issue

5 Suppl 2

First Page

S31

Comments

National Kidney Foundation Spring Clinical Meetings, May 6-10, 2026, New Orleans, LA

Last Page

S31

DOI

10.1053/j.ajkd.2026.02.069

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