Rhabdomyolysis, a devastating complication associated with statins, has been identified as a potentially fatal clinical entity. We presented the clinical presentation of an elderly male who suffered from chronic limb ischemia. Vascular duplex illustrated critical stenosis over bilateral lower extremities. Two-staged percutaneous transluminal angiography by local ballooning was performed to achieve adequate reperfusion. High dose atorvastatin was added after the procedure, conjunctionally with trimethoprim/sulfamethoxazole (TMP/SMX) against Stenotrophomonas strain over gangrene. Nevertheless, acute renal failure complicating metabolic acidosis and imbalanced electrolytes developed. Comprehensive workup rendered critical rhabdomyolysis with high McMahon score at 13. Drug related was favored after ruling out other etiologies. Statin was halted, and TMP/SMX was substituted with quinolone. Serum level of creatinine kinase was eventually normalized one week later, and kidney function was restored. Although rare, statin-related rhabdomyolysis is more common in elderly patients with comorbidities or polypharmacy. Administrating statin in individuals with labile host factors should be prudent and based on individualized considerations. TMP/SMX inhibits the statin catabolism only at excessively high serum concentration, while skeletal muscle injury secondary to TMP/SMX was reported predominantly in immunocompromised subjects. Once rhabdomyolysis has resolved, resuming lipid-lowering agents is recommended to prevent further cardiovascular events, particularly in high-risk populations.