The first patient was a 38-year-old woman who suffered from probable SARS during a nosocomial outbreak in Taiwan. She developed fever and chills on April 20, 2003. Her chest radiograph showed bilateral pneumonic patches. Because SARS was suspected, she was admitted to our hospital on April 28. She was intubated and given midazolam and succinylcholine for respiratory failure. Fever of up to 39 C was noted on the same day. Repeat blood, urine, and sputum cultures did not yield any pathogens. Vero cells from a throat swab yielded a coronavirus. SARS-associated coronavirus infection was confirmed by detection of coronavirus ribonucleic acid by real-time reverse transcription polymerase chain reaction tests from sputum. Serum creatine kinase level increased from 21 to 13,834 U/L from May 2 to 3, while serum creatinine level increased to 3.27 mg/dL. By May 6, serum creatine kinase level had increased to a peak value of 339,750 U/L, even after hydration and alkalization, while serum myoglobin level had increased to 167 ng/mL (normal, <70 ng/mL). Rhabdomyolysis was diagnosed clinically. Acute renal failure developed on May 4 and the patient went into a deep coma. She died 3 weeks later due to secondary bacterial infection despite mechanical ventilatory support, hemodialysis, and antibiotic treatment. A skeletal muscle biopsy specimen showed necrotic muscle fibers, basophilic change of sarcoplasm, enlarged vesicular nuclei, and centrally located nuclei.