Abstract
Rhabdomyolysis can cause complications such as acute kidney injury (AKI), with common etiologies including strenuous exercise, trauma, medications, and toxins. Given that creatine kinase (CK) levels of about 100,000 U/L are rare, this level of elevation may indicate the presence of an underlying contributor, such as excessive Pycnogenol intake, emphasizing the importance of taking a thorough patient history to identify factors that may otherwise be overlooked. We present a case of a 35‑year‑old previously healthy male who presented with diffuse myalgia, soreness, and tea‑colored urine two days after lifting furniture for a friend. The physical examination revealed mild tenderness and edema in his upper extremity muscles. Laboratory studies showed an initial CK of 154,000 U/L, aspartate aminotransferase (AST) of 2,400 U/L, alanine aminotransferase (ALT) of 700 U/L, and normal renal function (creatinine: 0.7-0.8 mg/dL throughout admission). Urine toxicology, viral serologies, and antinuclear antibody (ANA) were negative. During a subsequent interview, the patient disclosed consuming over-the-counter French maritime pine bark extract (Pycnogenol) in excess of the labeled recommendations. On day six of the patient's admission, the CK level declined to 7,874 U/L; transaminase levels decreased to AST of 252 U/L and ALT of 468 U/L with aggressive IV hydration. There was no evidence of kidney injury during the hospital course. This case suggests a potential association between excessive Pycnogenol consumption and severe rhabdomyolysis triggered by minimal physical activity, supported by a Naranjo score of 3. Clinicians should inquire about dietary supplement use when CK levels are disproportionately elevated relative to the inciting event.