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Asymptomatic HyperCKemia: A Diagnostic Trap.
Safia Shaikh1, Alan Gonzalez-Zapata2, Abdul Mujeeb3
1Internal Medicine, SSM Health St Mary's Hospital, St Louis, USA.
Cureus
|February 25, 2021
Summary
Extremely high creatine kinase (CK) levels, over 80 times normal, can occur asymptomatically due to macroCKemia. This rare condition involves decreased CK clearance, not muscle injury, preventing diagnostic errors.
Area of Science:
- Biochemistry
- Clinical Medicine
- Diagnostic Errors
Background:
- Elevated creatine kinase (CK) levels are a sensitive marker for muscle injury.
- CK levels >5000 U/L typically prompt aggressive hydration to prevent renal failure.
Observation:
- A rare case of asymptomatic hyperCKemia is presented, with CK levels exceeding 80 times the upper limit of normal (ULN).
- The patient's condition was refractory to standard fluid resuscitation protocols.
Findings:
- The cause of hyperCKemia was identified as macroCKemia, characterized by elevated macroenzymes.
- MacroCKemia leads to decreased clearance of CK, mimicking significant muscle damage.
Implications:
- This case highlights a benign cause of markedly elevated CK levels that can be mistaken for severe muscle injury.
- Recognizing macroCKemia is crucial to avoid unnecessary interventions and potential diagnostic/therapeutic errors.
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