Elevation of creatine kinase from skeletal muscle associated with inhaled albuterol

Background: Elevations of creatine kinase have been described, but have been associated with high doses of albuterol given by oral or intravenous routes. Most reports have described an elevation of MB isoenzyme fraction from the heart. Elevation of creatine kinase-MM isoenzyme from skeletal muscle rarely appears to be associated with the use of inhaled albuterol. Objective: A patient is discussed who presented with severe myalgias and was found to have elevated creatine kinase-MM from albuterol metered dose inhaler. Methods: Clinical status, creatine kinase levels, electromyography, enzyme stains, histopathologic and lactate challenge studies were done to evaluate the status of the patient. Results: Without exercise or use of albuterol, creatine kinase-MM levels were normal. With the use of albuterol, whether inhaled or by oral therapy, the creatine kinase-MM level increased. When combined with exercise, higher levels occurred. Workup was normal except histopathology revealed a myopathy. Conclusion: Patients with myalgias from albuterol with elevated creatine kinase-MM fraction should be investigated for possible myopathy.