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1.
Investigating raised creatine kinase.
Kim, EJ, Wierzbicki, AS
BMJ (Clinical research ed.). 2021;:n1486
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2.
Is alectinib-induced elevation of creatine phosphokinase a predictive factor for response? Report of two cases and review of the literature.
Shalata, W, Massalha, I, Agbarya, A
Anti-cancer drugs. 2021;(4):456-459
Abstract
We aim to describe two cases of creatine phosphokinase (CPK) and liver enzymes elevation occurring as adverse effects of alectinib (Alecensa) treatment for anaplastic lymphoma kinase (ALK)-mutated metastatic nonsmall cell lung cancer (NSCLC). A 56-year-old female and a 59-year-old male diagnosed with NSCLC exhibiting ALK gene rearrangements were treated by alectinib administration. The former had a complete response of widespread metastatic disease within 3 months, and the latter also had a substantial response. Both patients initially experienced an episode of CPK elevation and neither had dose modifications. At the end of the treatment, CPK and liver enzymes returned to normal range despite the continuation of alectinib full dose. A transient elevation of CPK and liver enzymes may take place during the alectinib treatment, indicating a tumor tissue damage thus contributing to a significant response.
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3.
Severe acute myopathy following SARS-CoV-2 infection: a case report and review of recent literature.
Islam, B, Ahmed, M, Islam, Z, Begum, SM
Skeletal muscle. 2021;(1):10
Abstract
BACKGROUND SARS-CoV2 virus could be potentially myopathic. Serum creatinine phosphokinase (CPK) is frequently found elevated in severe SARS-CoV2 infection, which indicates skeletal muscle damage precipitating limb weakness or even ventilatory failure. CASE PRESENTATION We addressed such a patient in his forties presented with features of severe SARS-CoV2 pneumonia and high serum CPK. He developed severe sepsis and acute respiratory distress syndrome (ARDS) and received intravenous high dose corticosteroid and tocilizumab to counter SARS-CoV2 associated cytokine surge. After 10 days of mechanical ventilation (MV), weaning was unsuccessful albeit apparently clear lung fields, having additionally severe and symmetric limb muscle weakness. Ancillary investigations in addition with serum CPK, including electromyogram, muscle biopsy, and muscle magnetic resonance imaging (MRI) suggested acute myopathy possibly due to skeletal myositis. CONCLUSION We wish to stress that myopathogenic medication in SARS-CoV2 pneumonia should be used with caution. Additionally, serum CPK could be a potential marker to predict respiratory failure in SARS-CoV2 pneumonia as skeletal myopathy affecting chest muscles may contribute ventilatory failure on top of oxygenation failure due to SARS-CoV2 pneumonia.
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4.
Persistently elevated CK and lysosomal storage myopathy associated with mucolipin 1 defects.
Zambon, AA, Lemaigre, A, Phadke, R, Grunewald, S, Sewry, C, Sarkozy, A, Clement, E, Muntoni, F, ,
Neuromuscular disorders : NMD. 2021;(3):212-217
Abstract
Mucolipidosis type IV is a rare autosomal recessive lysosomal storage disorder caused by bi-allelic pathogenic variants in the gene MCOLN1. This encodes for mucolipin-1 (ML1), an endo-lysosomal transmembrane Ca++ channel involved in vesicular trafficking. Although experimental models suggest that defects in mucolipin-1 can cause muscular dystrophy, putatively due to defective lysosomal-mediated sarcolemma repair, the role of mucolipin-1 in human muscle is still poorly deciphered. Elevation of creatine kinase (CK) had been reported in a few cases in the past but comprehensive descriptions of muscle pathology are lacking. Here we report a 7-year-old boy who underwent muscle biopsy due to persistently elevated CK levels (780-15,000 UI/L). Muscle pathology revealed features of a lysosomal storage myopathy with mild regenerative changes. Next generation sequencing confirmed homozygous nonsense variants in MCOLN1. This is a comprehensive pathological description of ML1-related myopathy, supporting the role of mucolipin-1 in muscle homoeostasis.
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5.
[Muscular polyarteritis nodosa-a case-based review].
Krusche, M, Ruffer, N, Kubacki, T, Matschke, J, Kötter, I
Zeitschrift fur Rheumatologie. 2019;(2):173-179
Abstract
BACKGROUND Myalgia is a common but unspecific set of symptoms that may be caused by orthopedic, neurological and internal medical conditions, often resulting in a diagnostic challenge. Muscular polyarteritis nodosa (PAN) is a rare differential diagnosis of myalgia with elevated serological inflammatory markers. OBJECTIVE Based on three clinical cases and the literature this review describes the essential clinical and diagnostic features of muscular PAN. RESULTS Muscular PAN typically presents with immobilizing myalgia confined to the lower limbs and elevated serological inflammatory markers but often normal creatine kinase (CK) levels. Contrast-enhanced magnetic resonance imaging of the affected muscles, which can often mimic myositis, and muscle biopsy provide the relevant histological findings that lead to the diagnosis of a vasculitis. CONCLUSION With respect to own experiences and the reviewed literature, muscular PAN should be considered as a possible diagnosis in cases of myalgia with elevated inflammatory markers but normal CK levels and a lack of further symptoms typical for vasculitis.
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6.
Cabozantinib-induced serum creatine kinase elevation and musculoskeletal complaints.
Stump, SE, Whang, YE, Crona, DJ
Investigational new drugs. 2018;(6):1143-1146
Abstract
Cabozantinib is a multikinase inhibitor approved for the treatment of metastatic medullary thyroid cancer and advanced renal cell carcinoma (RCC) in patients who have received prior anti-angiogenic therapy. While associations between serum creatine kinase (CK) elevations and other tyrosine kinase inhibitors used for the treatment of solid malignancies have been previously reported, we report a case of cabozantinib-associated CK elevation that was associated with musculoskeletal complaints by an RCC patient. Nine days following initiation of cabozantinib, the patient reported muscle cramps and serum CK had increased from levels 12 months earlier that were within normal limits to a grade 1 elevation of 244 units/L. Despite a dose reduction, her CK continued to rise over the next 2 months, leading to a peak CK of 914 units/L. Due to this grade 3 elevation, cabozantinib was permanently discontinued, and her CK subsequently returned to a grade 1 elevation within one week and then to baseline within 3 weeks. The temporal relationship between drug exposure and CK increase strongly suggests causality. To the authors' knowledge, this is the first reported case of CK elevation attributed to cabozantinib, but cabozantinib-induced CK elevations could be under-reported, and providers should monitor for musculoskeletal complaints during cabozantinib therapy.
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7.
Compartment syndrome after gynecologic laparoscopy: systematic review of the literature and establishment of normal values for postoperative serum creatine kinase and myoglobin levels.
Hefler-Frischmuth, K, Lafleur, J, Brunnmayr-Petkin, G, Roithmeier, F, Unterrichter, V, Hefler, L, Tempfer, C
Archives of gynecology and obstetrics. 2017;(2):285-293
Abstract
PURPOSE To evaluate published evidence in the literature on compartment syndrome (CS) in association with gynecologic surgery and to establish postoperative normal values for serum creatine kinase (CK) and myoglobin. METHODS The present study consists of a case report of a patient with CS, a systematic review including 37 studies and 86 patients with CS, and a retrospective cohort study of 300 patients undergoing various types of laparoscopy for benign or malignant diseases in order to establish postoperative normal values. RESULTS We report on a patient with early-stage ovarian cancer, who developed CS after laparoscopic surgery with massively elevated serum CK and myoglobin levels, i.e., 1109 U/L and 18151 µg/L, respectively. In our systematic review, median serum CK and myoglobin levels among women with CS were 19,223 (177-27,412) U/L and 1248 (285-1360) µg/L, respectively. In our cohort study, the median postoperative serum CK and myoglobin levels were 68 (14-1576) U/L and 45 (14-1040) µg/L, respectively. The 95th and 99th percentile of serum CK and myoglobin levels were 158 and 391.5 U/L, and 152.3 and 298.9 µg/L, respectively. CONCLUSION Markedly elevated postoperative serum levels of CK and myoglobin levels might raise the suspicion for CS and could therefore aid in the rapid diagnosis of CS.
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8.
Myasthenia triggered by immune checkpoint inhibitors: New case and literature review.
Gonzalez, NL, Puwanant, A, Lu, A, Marks, SM, Živković, SA
Neuromuscular disorders : NMD. 2017;(3):266-268
Abstract
Immune checkpoint molecules are potent regulators of immunologic homeostasis that prevent the development of autoimmunity while maintaining self-tolerance. Inhibitors of immune checkpoint molecules are used as immunotherapy in the treatment of melanoma and different types of refractory cancer, and can trigger various autoimmune complications including myositis and myasthenia gravis. We describe a case of generalized myasthenia gravis induced by pembrolizumab and review 11 other cases. Five patients also had elevated serum CK levels ranging from 1200 to 8729 IU/L, and biopsy showed myositis in one. Severity was highly variable as symptoms normalized spontaneously in one patient, but three others developed myasthenic crisis (including two with fatal outcomes). Steroids have been recommended as a preferred treatment of autoimmune complications of immune-checkpoint inhibitors. Myasthenia gravis should be considered when weakness, diplopia or bulbar symptoms are seen after treatment with immune checkpoint inhibitors, and additional studies are needed to characterize association with hyperCKemia.
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9.
Approach to the Patient With HyperCKemia.
Venance, SL
Continuum (Minneapolis, Minn.). 2016;(6, Muscle and Neuromuscular Junction Disorders):1803-1814
Abstract
PURPOSE OF REVIEW Neurologists commonly receive consultation requests regarding the evaluation of patients with an elevated serum creatine kinase (CK), a condition known as hyperCKemia. This article outlines an approach to the history and examination of patients with hyperCKemia in order to narrow the localization and differential of an elevated CK and guide possible next steps. This article aims to help clinicians identify treatable or reversible etiologies as well as those that will change management. RECENT FINDINGS An unrevealing patient history (assessing for acquired and hereditary etiologies) in an otherwise neurologically intact individual who has a normal nerve conduction study and EMG predicts that the likelihood of diagnosing the patient after further investigations will be quite low. After a comprehensive workup, a positive diagnosis is made in approximately 25% of cases of hyperCKemia. SUMMARY The best predictors for added diagnostic yield with further testing in hyperCKemia are a higher level of CK and a younger age; the presence of weakness increases the likelihood of a specific cause other than idiopathic or familial hyperCKemia. Many etiologies do not yet have treatments that alter clinical outcomes, and, even in the absence of a specific diagnosis, good communication with patients and primary care providers remains essential to ensure longitudinal surveillance with expectant management for potential consequences. Many patients with hyperCKemia of uncertain etiology, however, will not develop significant muscle disease on longitudinal follow-up.
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10.
Massive asymptomatic creatine kinase elevation in youth during antipsychotic drug treatment: case reports and critical review of the literature.
Masi, G, Milone, A, Viglione, V, Mancini, A, Pisano, S
Journal of child and adolescent psychopharmacology. 2014;(10):536-42
Abstract
A massive asymptomatic creatine kinase elevation (MACKE) has been described during antipsychotic exposure in adult psychotic patients without signs of neuroleptic malignant syndrome (NMS), or other most frequent reasons for high creatine kinase (CK) serum level (intramuscular injections, restraints, intense physical activity, dystonic reactions). In this article, we review this clinical condition, and report three cases of MACKE in nonpsychotic, drug-naïve youth during treatment with second generation antipsychotics. The diagnosis of MACKE should be considered after ruling out other possible common reasons of CK increase. The finding of MACKE should indicate a need for weekly monitoring of the CK level only when there are reasons to believe elevated CK is toxic or harmful. Further investigations are recommended when signs and symptoms raise a suspicion of NMS or rhabdomyolysis, including flu-like syndrome, fever, weakness, alteration of consciousness, muscle rigidity, tachycardia, hyper-/hypotension, and dark urine. A drug discontinuation should be considered when possible signs of NMS or rhabdomyolysis are suspected, or in cases of very high and persisting CK levels. Empirical evidence indicates that there is not a "safe" antipsychotic medication; therefore, a switch to another antipsychotic with a different profile is not necessarily a safe option. The spontaneously remitting or intermittent course suggests that the "true" MACKE should be kept distinct from both rhabdomyolysis and NMS. Raising awareness with MACKE may reduce the need for unnecessary diagnosis of NMS or rhabdomyolysis, which may otherwise lead to an unnecessary discontinuation of an effective therapeutic agent.