New York City Marathon runner's death highlights rare muscle-breakdown disorder

A 24-year-old Pennsylvania woman died Sunday night after collapsing roughly two miles from the finish of the TCS New York City Marathon, in an episode her father says doctors attributed to rhabdomyolysis, a rare but serious breakdown of muscle tissue that can be triggered by extreme physical exertion. The death, confirmed by CBS News and NBC News, has drawn renewed attention to a little-known condition that occasionally strikes endurance athletes, including first-time marathoners.

Rachel Apa, of Lewisberry, Pennsylvania, was running her first marathon on Nov. 1 when she had a medical emergency near mile 24 in Central Park. She was treated at the scene and taken by ambulance to Mount Sinai Hospital, where she was pronounced dead hours later. The city's Office of the Chief Medical Examiner said this week that it had not yet determined an official cause of death.

A collapse near mile 24

According to accounts given to CBS News, NBC News and ABC7 New York, Apa had been texting her father, Steve Apa, throughout the race. She reported feeling strong around mile 9, then described growing pain in later messages near mile 18 and beyond. Her mother, who was watching the course near mile 25, and a tracking app the family used to follow her progress both indicated she had stopped moving shortly after mile 24.

A nearby runner, Michaela Nicholas, told ABC7 she saw Apa collapse a few yards ahead of her. Bystanders, including doctors running in the crowd, began CPR after finding no pulse, and medical staff from New York Road Runners, the marathon's organizer, took over and used an automated external defibrillator before she was transported to the hospital. Her mother arrived at the scene shortly after the ambulance had already left for Mount Sinai.

Steve Apa, who drove to New York from Lewisberry after learning of the collapse, described the episode to NBC News as "unfathomable." He recalled his daughter as someone who was "always on the go," in school, in sports and in everything else. She had played Division I field hockey at Bucknell University, worked as a product manager, and had recently moved to Charleston, South Carolina, to pursue a master's degree while working remotely. She ran the race to raise money for the Parkinson's Foundation in memory of her grandfather, who had the disease.

What rhabdomyolysis does to the body

Rhabdomyolysis is the rapid breakdown of damaged skeletal muscle, which releases myoglobin, potassium and other cell contents into the bloodstream. According to the National Library of Medicine's MedlinePlus encyclopedia, the condition's causes include crush injuries, certain drugs and medications, extreme heat, low blood potassium or phosphate, and, notably, "severe exertion, such as marathon running." The excess myoglobin can overwhelm and injure the kidneys, while the surge in blood potassium can trigger dangerous heart rhythms. Symptoms typically include dark or cola-colored urine, muscle pain and weakness, though in severe cases the condition can progress quickly to organ failure.

Doctors who treated Apa described her case to the family as "extremely rare," according to NBC News' reporting. Exertional rhabdomyolysis has been documented in marathon and endurance-sports research for decades, though it remains uncommon relative to the number of people who finish long-distance races each year. A 2017 study in PLOS ONE examined genetic factors that may make some marathon runners more susceptible than others to the condition, underscoring that individual physiology, not just training or pacing, can play a role in who develops it. Standard treatment, per MedlinePlus, centers on large volumes of intravenous fluids and close monitoring of blood potassium; dialysis may be required if the kidneys fail.

Who is affected, and how rare the risk remains

Marathon running has grown steadily more popular with recreational and first-time participants over the past decade, a trend the TCS New York City Marathon reflects as one of the largest road races in the world, with tens of thousands of finishers each year. Serious, race-related medical emergencies remain statistically rare set against that field size, and New York Road Runners stations physicians, nurses and defibrillators along the course specifically to respond to cardiac and heat-related emergencies. Those on-course resources were used in Apa's case within minutes of her collapse, according to the family's account and news reports of the response.

Sports-medicine guidance generally recommends that runners build up training distance gradually, stay hydrated before and during long efforts, avoid racing while sick, and treat warning signs such as unusual muscle pain, dark urine or disproportionate fatigue as reasons to stop rather than push through. Those warnings are aimed broadly at recreational athletes training for their first marathon, a group race organizers and sports-medicine physicians have flagged in the past as needing more explicit guidance than elite competitors, who typically train under closer medical supervision.

Reaction from family and race organizers

New York Road Runners confirmed Apa's death but has not described its cause, deferring to the medical examiner's office.

"We are deeply saddened by Rachel's passing following running in Sunday's race," the organization said in a statement reported by CBS News.

The city's Office of the Chief Medical Examiner, the agency that investigates sudden and unexplained deaths in New York City, said Tuesday it was continuing its examination of Apa's death and had not yet determined an official cause. The office describes its broader mission, on its own site, as working to "protect public health and serve impartial justice through forensic science and medicine."

What happens next

The medical examiner's finding, once issued, is expected to be the first official confirmation of what caused Apa's death; rhabdomyolysis, as described by her family, remains the account given by treating physicians rather than a formal ruling. New York Road Runners has not announced any change to its medical protocols in response to the death. Physiologist and anesthesiologist Dr. Michael Joyner, quoted in a CBS News explainer on the condition, has said the key factor in outcomes is how quickly rhabdomyolysis is recognized and treated: "Prompt treatment can really make a huge difference." For now, the case has chiefly become an occasion for doctors to remind recreational runners, especially those training for a first marathon, that extreme exertion carries real if uncommon risks, and that early treatment of rhabdomyolysis substantially improves the odds of a full recovery.