Critically High CPK, followed by high LDH

[jjd3rd]

I am a 20 year old overweight male student studying biology. Past history of bell's pausey (had tube placed in my ear), IBS, anxiety, rapid HR, acne, severe keratosis pilaris/foliculitis/dermatitis, subaceous cysts, and elevated ALT/AST once in the past (followup studies LFTs, Ferritin, Fe, etc were all normal). I am currently taking no medications, and have only taken antibiotics for skin infections and was once on toprol for HR control.

Family history of hypo and hyperthyroidism, heart disease, colon cancer

I was recently hospitalized and diagnosed with Rhabdomyolisis, however there was no physical reason for it to have occurred. I went to the ER when I noticed my heartrate was very high for no reason along with SOB. My blood pressure was high, but it didn't get too high and was normal while I was sitting, although my heartrate remained high.

My original CPK was over 6000, the MB wasn't very much (8.95). I was given intravenous fluids, and over the course of 8 hours it came down to 3666 (MB 6.05), 6 hours after that it only dropped to 3570 (MB 7.04). My Troponins were all negative, slight TR. Avg hr 78, lowest 42, highest 150.  Xray showed was mild disc degeneration since 2 years ago (I had come to the ER with rapid HR before) along with low volumes with no evidence of consolidation. Questionable change in QRS axis since my visit in 2007. The only other notable tests were a *slightly low T4 (5.47) TSH was 2.41 (normal) and Chloride of 112 in the morning during admission. The Chloride was normal (107) when I entered the ER.

Over a month after the fact I have been retested. My CPK is still elevated at 406. My LDH was tested and is elevated at 689. My ALT is elevated at 99, but my AST is normal. The only other flag on the chem panel was Cl at 108. My CBC was virtually normal, with flags of 31.4 MCH and 0.8 Abs Monos. Here's the kicker, my aldolase is normal at 5.8. The ANA is still pending.

Thank you for your help!!

[J.M. Keyes, MD]

I am assuming there was no trauma to the muscles.  Intense exercise can also cause an increase in the skeletal muscle form of CPK (CPK-MM). Certain drugs such as cholesterol lowering drugs (statins) can damage muscle and elevate CPK. Other causes are alcohol, viruses, hereditary conditions. CPK can be elevated in certain autoimmune diseases that cause inflammation in the muscle such as polymyositis or dermatomyositis.
I think because of the levels of your CPK, you really should be followed up to look for a cause.  I would suggest seeing a rheumatologist, and bringing all of your previous blood work results, and testing so that they can see it first hand.

I am sorry to hear that you have had so many medical issues at such a young age.
Best of luck.

JMK MD

[jjd3rd]

I also forgot to add, there is a C-reactive protein pending along with the ANA. Sorry if it seemed a little choppy, I hit the 2000 character limit!

Thanks again, so much.

[jjd3rd]

CRP and ANA were negative

[jjd3rd]

Thanks Dr. Keyes!