An Unusual Cause for High Creatine Kinase Levels in an Acute Care Setting


Authors : Amina Yousuf Shaikh

Volume/Issue : Volume 10 - 2025, Issue 3 - March


Google Scholar : https://tinyurl.com/mrcmw92f

Scribd : https://tinyurl.com/bdh7acat

DOI : https://doi.org/10.38124/ijisrt/25mar1095

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Abstract : Ryanodine receptor 1 (RyR1) group of myopathies are rare disorders with a fairly common initial presentation. A high index of suspicion while evaluating patients being readmitted with similar presentations in the Acute Medical Units (AMU) can aid diagnosis of rare diseases. We report the scenario of a young gentleman who presented to AMU with severe myalgia for one week. His creatine kinase (CK) levels were considerably high. He was further investigated following MDT (Multi-Disciplinary Team) discussion. He was diagnosed with exercise induced rise in CK levels, and discharged. Two months later, he represented to the A&E (Accident & Emergency department) and was admitted to the AMU with the same complaints. Thorough investigations raised the suspicion of a genetic disease and a muscle biopsy was planned. He was referred to specialised neuromuscular services in the country for further evaluation where he was diagnosed to have a RYR1-related myopathy, which is a rare congenital muscle disease, resulting from an alteration in the RYR1 gene.

Keywords : Ryanodine Receptor 1, RYR1, Myopathy, Genetic, Creatine Kinase, Acute Medical Unit.

References :

        1. Lawal, T.A., Todd, J.J., Witherspoon, J.W. et al. Ryanodine receptor 1-related disorders: an historical perspective and proposal for a unified nomenclature. Skeletal Muscle 10, 32 (2020).
        2. Lawal TA, Todd JJ, Meilleur KG. Ryanodine Receptor 1-Related Myopathies: Diagnostic and Therapeutic Approaches. Neurotherapeutics. 2018 Oct;15(4):885-899.
        3. Witherspoon JW, Meilleur KG. Review of RyR1 pathway and associated pathomechanisms. Acta Neuropathol Commun 2016;4:121
        4.  Jungbluth H, Sewry CA and Muntoni F. Core myopathies. Semin Pediatr Neurol. 2011; 18(4):239-49.
        5. Voermans NC, Snoeck M, Jungbluth H. RYR1-related rhabdomyolysis: A common but probably underdiagnosed manifestation of skeletal muscle ryanodine receptor dysfunction. Rev Neurol (Paris). 2016 Oct;172(10):546-558.
        6. Scalco RS, Snoeck M, Quinlivan R, Treves S, Laforét P, Jungbluth H, Voermans NC. Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy? BMJ Open Sport Exerc Med. 2016 Sep 7;2(1):e000151
        7. Voermans, N. C., Snoeck, M., & Jungbluth, H. (2016). RYR1-related rhabdomyolysis: A common but probably underdiagnosed manifestation of defective skeletal muscle ryanodine receptor dysfunction. Revue Neurologique

Ryanodine receptor 1 (RyR1) group of myopathies are rare disorders with a fairly common initial presentation. A high index of suspicion while evaluating patients being readmitted with similar presentations in the Acute Medical Units (AMU) can aid diagnosis of rare diseases. We report the scenario of a young gentleman who presented to AMU with severe myalgia for one week. His creatine kinase (CK) levels were considerably high. He was further investigated following MDT (Multi-Disciplinary Team) discussion. He was diagnosed with exercise induced rise in CK levels, and discharged. Two months later, he represented to the A&E (Accident & Emergency department) and was admitted to the AMU with the same complaints. Thorough investigations raised the suspicion of a genetic disease and a muscle biopsy was planned. He was referred to specialised neuromuscular services in the country for further evaluation where he was diagnosed to have a RYR1-related myopathy, which is a rare congenital muscle disease, resulting from an alteration in the RYR1 gene.

Keywords : Ryanodine Receptor 1, RYR1, Myopathy, Genetic, Creatine Kinase, Acute Medical Unit.

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