Abstract
The isoenzyme creatine kinase muscle/brain (CK-MB) still plays an important role for the differential diagnosis of CK elevations and the clarification of their origin from heart or skeletal muscle. Therefore, it is necessary to know the diagnostic pitfalls in interpreting CK-MB results. We demonstrate a case of macro-CK type 2 in a 75-year-old patient with metastatic castration-resistant prostate cancer and its identification by isoenzyme electrophoresis, which can be typical for cancer diseases.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Task force for the universal definition of myocardial infarction: third universal definition of myocardial infarction. Nat Rev Cardiol 2012;9:620–33.10.1038/nrcardio.2012.122Search in Google Scholar
2. Axinte C, Alexa T, Cracana I, Alexa ID. Macro-creatine kinase syndrome as an underdiagnosed cause of ck-mb increase in the absence of myocardial infarction: two case reports. Rev Med Chir Soc Med Nat Iasi 2012;116:1033–8.Search in Google Scholar
3. Sturk A, Sanders GT. Macro enzymes: prevalence, composition, detection and clinical relevance. J Clin Chem Clin Biochem 1990;28:65–81.10.1177/006947709002800111Search in Google Scholar
4. Remaley AT, Wilding P. Macroenzymes: biochemical characterization, clinical significance, and laboratory detection. Clin Chem 1989;35:2261–70.10.1093/clinchem/35.12.2261Search in Google Scholar
5. Lee, Csako G, Bernhardt P, Elin RJ. Relevance of macro creatine kinase type 1 and type 2 isoenzymes to laboratory and clinical data. Clin Chem 1994;40(Pt 1):1278–83.10.1093/clinchem/40.7.1278Search in Google Scholar
6. Liu CY, Lai YC, Wu YC, Tzeng CH, Lee SD. Macroenzyme creatine kinase in the era of modern laboratory medicine. J Chin Med Assoc 2010;73:35–9.10.1016/S1726-4901(10)70019-8Search in Google Scholar
7. Tsung JS. Creatine kinase and its isoenzymes in neoplastic disease. Crit Rev Clin Lab Sci 1986;23:65–75.10.3109/10408368609165795Search in Google Scholar
8. Aljuani F, Tournadre A, Cecchetti S, Soubrier M, Dubost JJ. Macro-creatine kinase: a neglected cause of elevated creatine kinase. Intern Med J 2015;45:457–9.10.1111/imj.12710Search in Google Scholar
9. Laureys M, Sion JP, Slabbynck H, Steenssens L, Cobbaert C, Derde MP, et al. Macromolecular creatine kinase type 1: a serum marker associated with disease. Clin Chem 1991;37:430–4.10.1093/clinchem/37.3.430Search in Google Scholar
10. Arenas J, Bornstein B, Mayor JJ, Santos I, Leiva O, Martínez A. Macro creatine kinase type 2 in a patient with prostatic carcinoma. Clin Chim Acta 1991;200:53–6.10.1016/0009-8981(91)90334-9Search in Google Scholar
11. Loh TP, Ang YH, Neo SF, Yin C, Wong MS, Leong SM, et al. Immunoglobulin-associated creatine kinase masquerading as macro-creatine kinase type 2 in a statin user. Intern Med 2012;51:1061–4.10.2169/internalmedicine.51.7157Search in Google Scholar PubMed
12. Schmid H, Tokarska-Schlattner M, Füeßl B, Röder M, Kay L, Attia S, et al. Macro CK2 accumulation in tenofovir-treated HIV patients is facilitated by CK oligomer stabilization but is not predictive for pathology. Antivir Ther 2013; 18:193–204.10.3851/IMP2313Search in Google Scholar PubMed
13. Lang H, Würzburg U. Creatine kinase, an enzyme of many forms. Clin Chem 1982;28:1439–47.10.1093/clinchem/28.7.1439Search in Google Scholar
©2019 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Editorial
- The Model List of Essential In Vitro Diagnostics: nuisance or opportunity?
- Reviews
- Skeletal myopathies as a non-cardiac cause of elevations of cardiac troponin concentrations
- Histo-genomics: digital pathology at the forefront of precision medicine
- Opinion Papers
- Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety
- Understanding the “philosophy” of laboratory hemostasis
- Original Articles
- Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers
- Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process
- Mortality and morbidity rounds (MMR) in pathology: relative contribution of cognitive bias vs. systems failures to diagnostic error
- Experienced physician descriptions of intuition in clinical reasoning: a typology
- A randomized experimental study to assess the effect of language on medical students’ anxiety due to uncertainty
- Development and application of a PCR-HRM molecular diagnostic method of SNPs linked with TNF inhibitor efficacy
- Acute rejection in kidney transplantation and the evaluation of associated polymorphisms (SNPs): the importance of sample size
- Letter to the Editor
- Physically damaged second victims by diagnostic delay in pulmonary tuberculosis of hospitalized patients. Cognitive errors with urgent need for prevention
- The physical examination, including point of care technology, is an important part of the diagnostic process and should be included in educational interventions to improve clinical reasoning
- Case Reports
- Case reports of diagnostic error: liposarcoma mistaken for hematoma in an obese female with concurrent ipsilateral thrombosis on rivaroxaban
- Macro-CK type 2 in metastatic prostate cancer
Articles in the same Issue
- Frontmatter
- Editorial
- The Model List of Essential In Vitro Diagnostics: nuisance or opportunity?
- Reviews
- Skeletal myopathies as a non-cardiac cause of elevations of cardiac troponin concentrations
- Histo-genomics: digital pathology at the forefront of precision medicine
- Opinion Papers
- Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety
- Understanding the “philosophy” of laboratory hemostasis
- Original Articles
- Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers
- Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process
- Mortality and morbidity rounds (MMR) in pathology: relative contribution of cognitive bias vs. systems failures to diagnostic error
- Experienced physician descriptions of intuition in clinical reasoning: a typology
- A randomized experimental study to assess the effect of language on medical students’ anxiety due to uncertainty
- Development and application of a PCR-HRM molecular diagnostic method of SNPs linked with TNF inhibitor efficacy
- Acute rejection in kidney transplantation and the evaluation of associated polymorphisms (SNPs): the importance of sample size
- Letter to the Editor
- Physically damaged second victims by diagnostic delay in pulmonary tuberculosis of hospitalized patients. Cognitive errors with urgent need for prevention
- The physical examination, including point of care technology, is an important part of the diagnostic process and should be included in educational interventions to improve clinical reasoning
- Case Reports
- Case reports of diagnostic error: liposarcoma mistaken for hematoma in an obese female with concurrent ipsilateral thrombosis on rivaroxaban
- Macro-CK type 2 in metastatic prostate cancer