Therefore, it is proposed that on the basis of lipid metabolic defects due to the c.250G>A (p.Ala84Thr) mutation in ETFDH, anorexia and immune dysfunction after academic stress and fatigue, together with delayed medical care and pulmonary infection may have exacerbated the MADD, leading to progressive muscular symptoms, and even multi-organ failure. Here, ETFDH is linked to immune system disorder.