I came across the following issue in my psychiatry rounds. This is a 46 year old African American male patient who has had persistently elevated CPK's and at one
point even the MB fraction was slightly elevated. The highest CPK was up to
1500. Now it is lingering in the 400's. MB is normal. Trop I has been normal. He
is not clear about muscle aches, but he does get up feeling stiff. He is newly
diabetic, and has not been on statins that obviously could cause myositis.
What should be done? I already talked to a fellow neurologist that
told me this could be benign. But what does it mean?
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An elevated CPK or CK(creatine kinase) level in serum results usually form the breakdown or inflammation of muscle cells. You obviously think of skeletal muscle and also the myocardium. In this case, the injury to the myocardium (ischemia, infarction or inflammatory) is very unlikely because as youpoint out the troponin is negative.
ReplyDeleteSince your patient has no muscel pains, aches or renal failure, we must suspect another alternative. The possibilities are 2: First is there a MARCROENZYME? And seocnd, is there a tumor producing CK? The first alternativeis the MOST COMMON answer. The presence of a macroenzyme may be due to conglomerates of the enzyme formed biochemically (type 1) or form linkages between individual enzyme molecules via immunoglobulins Type 2.
I hope this helps.