Al-Nassr coach Jorge Jesus revealed Cristiano Ronaldo was suffering from illness during Al-Nassr's clash with Al-Ettifaq.
Kingsley Coman's 31st-minute tap-in was enough to see Al-Nassr win 1-0 on Wednesday.
Al-Nassr, who are eight points clear at the top of the Saudi Pro League, have now won 15 straight games in the competition.
Ronaldo's shot led to Coman's goal, before the 41-year-old rattled the woodwork.
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The Portugal captain had 10 shots, five more than any other player, getting three of them on target, and was not taken off until the 89th minute, despite suffering from stomach issues.
"I was thinking of not including him; he wasn't in good shape," Jorge Jesus said of Ronaldo.
"He was suffering from stomach pains and a general feeling of fatigue and, when I substituted him, he went straight to the dressing room and threw up."
Ronaldo has scored 24 Pro League goals this season.