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We discuss two adult siblings who presented with symptoms of myalgia and rhabdomyolysis following exercise with myoglobinuria; genetic testing confirmed carnitine palmitoyltransferase II deficiency and resulted in institution of appropriate crisis management and dietary advice. We explore the phenotypic variability of this commonest fatty oxidation defect that remains under-diagnosed in the adult population and provide clues for early recognition and diagnosis. Keywords: Myoglobinuria, CPT II deficiency, Autosomal recessive, Genetic counselling, Dietary advice, Rhabdomyolysis, Myopathy