From weight loss to muscle loss: rhabdomyolysis linked to semaglutide

Abstract Rhabdomyolysis is a clinical syndrome characterized by the breakdown of skeletal muscle, leading to the release of creatine kinase (CK), myoglobin, and electrolytes into the circulation. This can result in acute kidney injury and other complications. Common etiologies include trauma, medications, and metabolic disorders. We report a case of semaglutide-associated rhabdomyolysis in a 36-year-old obese male who presented with bilateral lower extremity pain, cramping, and dark urine six days after increasing his weekly dose from 1.7 mg to 2.4 mg. The dose had been titrated weekly from 0.25 mg to 1.0 mg, then to 1.7 mg, and finally to 2.4 mg. Laboratory evaluation revealed markedly elevated CK (16,202 U/L; normal: 20-200 U/L) and liver enzymes (aspartate aminotransferase: 279 U/L, alanine aminotransferase: 77 U/L), consistent with rhabdomyolysis. After excluding other common causes through clinical assessment and diagnostic workup, this case underscores the importance of recognizing this rare but potentially serious adverse effect of semaglutide.