Rhabdomyolysis Associated With Excess Pycnogenol (Maritime Pine Bark Extract): A Case Report

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.