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Case 324: CHANTER Syndrome
Pokhraj Prakashchandra Suthar1, Kathryn Hughes1, Mustafa Mafraji1
1From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612.
Radiology
|April 30, 2024
Summary
An unresponsive patient with multiple substance use disorders presented with extremely elevated creatine kinase levels. Despite naloxone, the patient remained unresponsive, necessitating intubation and further neuroimaging for diagnosis.
Area of Science:
- Neurology
- Toxicology
- Emergency Medicine
Background:
- A 69-year-old male with a history of substance use disorder, hypertension, and diabetes presented with unresponsiveness.
- Vital signs were largely stable, with the exception of tachycardia (108 bpm).
Observation:
- Physical examination was unremarkable apart from a Glasgow Coma Scale score of 8.
- Laboratory results revealed markedly elevated creatine kinase (49,006 U/L) and elevated liver enzymes (ALT, AST).
- Urine drug screening was positive for cocaine, marijuana, fentanyl, and benzodiazepines.
Findings:
- The patient remained unresponsive after naloxone administration.
- Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain were performed to exclude intracranial abnormalities.
- The extreme creatine kinase elevation in the context of polysubstance intoxication suggests potential rhabdomyolysis or other severe systemic effects.
Implications:
- This case highlights the diagnostic challenges in unresponsive patients with polysubstance intoxication.
- Prompt neuroimaging and laboratory evaluation are crucial for identifying potential causes and guiding management.
- The etiology of the extreme creatine kinase elevation requires further investigation, potentially related to substance toxicity or associated complications.
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