Asymptomatic HyperCKemia: A Diagnostic Trap

Abstract

Elevated creatine kinase (CK) levels are the most sensitive indicator of muscle injury. Levels >5000 U/L warns physicians to initiate aggressive hydration and prevent renal failure. We present a rare case of asymptomatic hyperCkemia with levels >80 times the upper limit of normal (ULN), refractory to fluid resuscitation. Our patient was found to have elevated macroenzymes- macroCkemia, causing decreased clearance of CK. The objective of this case report is to bring to attention a rare and benign cause of CK elevation which can lead to diagnostic and therapeutic errors.

Methylphenidate-Associated Creatine Kinase Level Elevation

“…In 2023, brexpiprazole, widely prescribed for schizophrenia and major depressive disorder, became the first US Food and Drug Administration-approved treatment for agitation in Alzheimer dementia. 3 This marks a promising, effective, and well-tolerated option for individuals with BPSD. 3,4 In this case, we document a patient diagnosed with dementia with Lewy bodies (DLB) and accompanying BPSD and agitation, managed with the use of brexpiprazole during admission.…”

“…3 This marks a promising, effective, and well-tolerated option for individuals with BPSD. 3,4 In this case, we document a patient diagnosed with dementia with Lewy bodies (DLB) and accompanying BPSD and agitation, managed with the use of brexpiprazole during admission.…”

“…Maiko Nagaoka, MD, MPH 1,2 Tsukasa Murata, MP, BCPPS 1 Takahiko Nagamine, MD, PhD 3 Noboru Fujise, MD, PhD 2 1 Kumamoto Seimei Hospital, Kumamoto, Japan 2 Health Care Center, Kumamoto University, Kumamoto, Japan 3 Sunlight Brain Research Center, Yamaguchi, Japan To the Editor: Behavioral and psychological symptoms of dementia (BPSD) encompass mood, behavior, thought, and perception disruptions associated with dementia. BPSD can be distressing, leading to increased caregiver burden, reduced quality of life, and higher hospitalization and institutionalization risks.…”

“…Common causes of elevated CK include trauma, exercise, inflammatory disorders, myopathies, and medications (commonly statins). 3 In this case, in light of the clinical signs and laboratory findings, neuroleptic malignant syndrome, myocardial infarction or other cardiac disease, and hypothyroidism were excluded. Rhabdomyolysis could not be excluded owing to a lack of urinalysis, but brown urine was not observed (as confirmed by interview), and kidney function was normal; therefore, rhabdomyolysis was ruled out.…”