Exertional Rhabdomyolysis With Moderate Creatine Kinase Elevation and Marked Transaminase Elevation but Preserved Synthetic Function: A Case Report.
Li Chu, Xianyu Lv, Yili Bai et al.
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Case in brief
A 43-year-old man presented with fatigue, nausea, and myalgia following a 3000-m run. Laboratory tests revealed moderate creatine kinase (CK) elevation at 2828 U/L alongside significantly elevated transaminases: AST at 2294 U/L and ALT at 1554 U/L. Despite these findings, synthetic liver function remained intact. The patient was treated with intravenous fluids and urine alkalinization, leading to a rapid decline in enzyme levels and an asymptomatic discharge after 8 days.
What made this case unusual
This case highlights marked transaminase elevation in exertional rhabdomyolysis with only moderate CK elevation, challenging the typical association between CK levels and liver enzyme elevations.
Diagnostic / clinical pearl
Clinicians should be aware that significant transaminase elevations can occur in exertional rhabdomyolysis even with moderate CK levels, and this may not indicate severe liver injury.
Why it matters
Understanding this atypical presentation can guide appropriate management and prevent unnecessary interventions in patients with preserved synthetic liver function.