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Case Reports
. 2022 May 22;14(5):e25201.
doi: 10.7759/cureus.25201. eCollection 2022 May.

Extraordinary Creatine Phosphokinase Levels in Coxsackie B Necrotizing Myopathy Complicated by Rhabdomyolysis

Jacob Alex  1 , Elise Landa  2 , Arjun Trivedi  1 , Leo M Parsons Ii  3 , Nabeel Shabo  1
Affiliations
Case Reports

Extraordinary Creatine Phosphokinase Levels in Coxsackie B Necrotizing Myopathy Complicated by Rhabdomyolysis

Jacob Alex et al. Cureus. .

Abstract

Coxsackie B infections can have varying clinical presentations. Necrotizing myopathy and rhabdomyolysis with remarkably high creatine phosphokinase levels is a rare complication associated with high morbidity and mortality. A 28-year-old male presented with complaints of weakness, body aches, and decreased urine output. Initial lab work showed a creatine phosphokinase level estimated at 5,366,100 U/l. Initial Coxsackie B4 titers were at 1:160. Muscle biopsy of the right calf revealed necrotizing myopathy consistent with viral myopathy. This case highlights Coxsackie B4 as a potential pathogen that can cause extensive muscle necrosis producing extreme creatine phosphokinase levels leading to rhabdomyolysis. Taking a comprehensive history is essential to identify viral prodromal symptoms to guide broader serological testing for uncommon viral species.

Keywords: acute renal failure; coxsackie b; creatine phosphokinase; necrotizing myopathy; rhabdomyolysis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Right calf muscle biopsy showing necrotizing myopathy
Figure 2
Figure 2. Creatine kinase and serum creatinine level trends during initial 10 days of inpatient admission
See this image and copyright information in PMC

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