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Malignant hyperthermia is a pharmacogenetic disease in which a hypermetabolic reaction is triggered in malignant hyperthermia\u2010susceptible patients by specific anesthetic agents. We present a clinical case of a fatal atypical reaction to anesthesia, where mitochondrial dysfunction was identified in the mother, and a variant in the\n                    <jats:italic>RYR1<\/jats:italic>\n                    gene was found in the asymptomatic father and a paternal first cousin with exercise\u2010induced rhabdomyolysis. Our report highlights that patients with complex phenotypes may present with concomitant diseases, necessitating comprehensive and often competing management priorities.\n                  <\/jats:p>","DOI":"10.1155\/crnm\/5802797","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:26:44Z","timestamp":1790684804000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lightning Strikes Twice in the Same Place: Mitochondrial Myopathy and Malignant Hyperthermia\u2014A Case Report"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4323-6059","authenticated-orcid":false,"given":"Rafaela Souto e Souza de","family":"Melo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0261-4359","authenticated-orcid":false,"given":"Jorge Kiyoshi","family":"Mitsunaga 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