A 28-year-old woman from Delhi presents with progressive muscle weakness, myalgia, and dark urine after a 48-hour viral illness with fever and vomiting. On examination, she has proximal muscle tenderness and mild hepatomegaly. Laboratory findings: CK 8,500 U/L (normal <200), myoglobin in urine (3+), serum carnitine 18 μmol/L (normal 40–60), and acylcarnitine profile shows elevated long-chain acylcarnitines (C16, C18). Fasting serum glucose is 72 mg/dL. A diagnosis of carnitine palmitoyltransferase II (CPT II) deficiency is considered. Which of the following best explains why this patient developed rhabdomyolysis despite normal blood glucose?
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