ELEVATION OF CREATINE-KINASE FROM SKELETAL-MUSCLE ASSOCIATED WITH INHALED ALBUTEROL

Background: Elevations of creatine kinase have been described, but hav e been associated with high doses of albuterol given by oral or intrav enous routes. Most reports have described an elevation of MB isoenzyme fraction from the heart. Elevation of creatine kinase MM isoenzyme fr om skeletal muscle rarely appears to be associated with the use of inh aled albuterol. Objective: A patient is discussed who presented with s evere myalgias and was found to have elevated creatine kinase-MM from albuterol metered dose inhaler. Methods: Clinical status, creatine kin ase levels, electromyography, enzyme stains, histopathologic and lacta te challenge studies were done to evaluate the status of the patient. Results: Without exercise or use of albuterol, creatine kinase-MM leve ls were normal. With the use of albuterol, whether inhaled or by oral therapy, the creatine kinase-MM level increased. When combined with ex ercise, higher levels occurred. Workup was normal except histopatholog y revealed a myopathy. Conclusion: Patients with myalgias from albuter ol with elevated creatine kinase-MM fraction should be investigated fo r possible myopathy.