Exercise-induced muscle damage commonly occurs following unaccustomed physical activity that particularly involves eccentric contractions of greater than normal duration and intensity. We present a case of exercise-induced muscle damage in quadriceps on both side leading to a substantial elevation in liver and muscle enzymes. A 33-year old male patients presented with anterior thigh pain on both side. His complaints began following a bout of squatting exercise compromising 70 squats three days ago on a first day of fitness center he had newly registered. He experienced difficulty of walking due to anterior thigh pain and his urine turned red the next day. The physical examination revealed tenderness with palpation and weakness in bilateral quadriceps muscles. There was a substantial elevation in muscle (creatine kinase: 54760 U/L) and liver enzymes (alanine aminotransferase: 344 U/L, aspartate aminotransferase: 1164 U/L) in the blood test. Hematuria and proteinuria was seen in the urine test. T2 weighted MRI of the upper leg showed diffuse increase in signal intensity (indicating edema) in bilateral quadriceps muscles. The findings were consistent with exercise-induced quadriceps muscles damage. The patient was hospitalized. I.v. fluids therapy (normal saline 200 ml per hour and 5% dextrose 50 mL per hour) was administered. Abnormality in laboratory tests improved within a week. Exercise-induced muscle damage may result in important metabolic consequences. Blood tests and MRI of involved muscles can be used for diagnosis.