A case against the specificity of "cardiac" troponin-T

A case of a spurious rise in cardiac troponin-T in an 85 year old Caucasian man with myelodysplastic syndrome and multiple malignancies but with intact cardiac and renal function is reported. The patient presented to the accident and emergency department with fever and chest pain. Inconsistent laboratory findings in biochemical markers diagnostic of myocardial infarction were observed. Discrepant findings included a rise in the concentration of the cardiac specific marker troponin-T in the absence of an increase in creatine kinase (CK) isoenzyme MB activity. Somewhat surprisingly, there was a significant and consistent increase in CK isoenzyme BB activity. Awareness of the increase in troponin-T concentrations in patients with multiple clinical non-cardiac problems may prevent an erroneous diagnosis of myocardial infarction and avert institution of unduly aggressive treatment.