Exceptionally High Creatine Kinase (CK) Levels in Multicausal and Complicated Rhabdomyolysis: A Case Report

Abstract

Patient: Male, 36Final Diagnosis: Rhabdomyolysis induced acute renal failureSymptoms: Diarrhea • generalized weaknessMedication: —Clinical Procedure: Hemodialysis • intubationSpecialty: Critical Care MedicineObjective:Unusual setting of medical careBackground:Rhabdomyolysis is a syndrome caused by muscle breakdown. It can be caused by traumatic as well as non-traumatic factors such as drugs, toxins, and infections. Although it has been initially associated with only traumatic causes, non-traumatic causes now appear to be at least 5 times more frequent. In rhabdomyolysis, the CK levels can range anywhere from 10 000 to 200 000 or even higher. The higher the CK levels, the greater will be the renal damage and associated complications.We present the case of a patient with exceptionally massive rhabdomyolysis with unusually high CK levels (nearly 1 million) caused by combined etiologic factors and complicated with acute renal failure.Case Report:A 36-year-old African American male patient with no significant past medical history and a social history of cocaine and alcohol abuse presented with diarrhea and generalized weakness of 2 days’ duration. He was found to be febrile, tachycardic, tachypneic, and hypoxic. The patient was subsequently intubated and admitted to the medical ICU. Laboratory work-up showed acute renal failure with deranged liver functions test results, and elevated creatine kinase of 701,400 U/L. CK levels were subsequently too high for the lab to quantify. Urine legionella testing was positive for L. pneumophilia serogroup 1 antigen and urine toxicology was positive for cocaine. The patient had a protracted course in the ICU. He was initially started on CVVH, and later received intermittent hemodialysis for about 1 month.Conclusions:In the presence of multiple etiologic factors, rhabdomyolysis can be massive with resultant significant morbidity. Clinicians should have a high index of suspicion for rhabdomyolysis in the presence of multiple factors, as early recognition of this diseases is very important in the prevention and active management of life-threatening conditions.

Heavy metal pollution and risk assessment by the battery of toxicity tests

“…CK employ adenosine-triphosphate to catalyze the transformation of creatine into adenosine diphosphate and phosphocreatine. The higher the CK activity higher the tissue damage causing acute kidney injury, rhabdomyolysis, muscular dystrophy, myocardial infarction and autoimmune myositis 28,29 .…”

Extreme Rhabdomyolysis, Acute Renal Failure, and Protracted Ileus in a Case of Legionella Pneumonia

“…Since that time, at least 17 additional cases have been reported in the literature [6–22]. Our patient had one of the highest ever reported CK levels [23]. The exact mechanism leading to muscular injury in case of Legionella infection remains unclear.…”

Dermatomyositis-Induced Rhabdomyolysis With Features of Necrotizing Myopathy and Acute Inflammatory Demyelinating Polyneuropathy in an Epstein-Barr Virus Infected Patient

“…Various case reports on IMNM describe CK levels rising to around 28,000 iU/L. In one of the largest case studies, the mean peak CK reported for each of a variety of different causes ranged from approximately 10,000 to 25,000 iU/L [ 4 ]. To our knowledge, our patient’s CK levels were one of the highest recorded, at 36,000 then 53,000 iU/L on relapse.…”