• Antonia-Therese Kietaibl, Maria Fangmeyer-Binder, Gabor Göndör, Marcus Säemann, and Peter Fasching.
• Department of 5th Internal Medicine with Endocrinology, Rheumatology and Gerontology with Outpatient Department, Clinic Ottakring, Montleartstraße 37, 1160, Vienna, Austria. antonia-therese.kietaibl@gesundheitsverbund.at.
• Wien. Klin. Wochenschr. 2021 Aug 1; 133 (15-16): 847-850.

BackgroundAcute viral myositis (AVM) may be triggered by influenza A/B, enteroviruses and other viruses. Severe complications including rhabdomyolysis regularly lead to acute kidney injury (AKI). The aim of this short report was to discuss management and differential diagnosis of massive creatine kinase (CK) elevation.Patient, Material And MethodsHerein, we report on a 19-year-old Austrian male of African descent with a history of respiratory tract infections and whole-body pain. He further developed acute viral myositis and massive CK elevation up to 440,000 IU/L but without any signs of AKI. A literature search relating AVM, management and differential diagnosis of rhabdomyolysis was conducted in PubMed and UptoDate.ResultsA full panel of serological and autoimmune blood work-up including testing for human immunodeficiency virus (HIV), hepatitis, influenza A/B, Epstein-Barr virus (EBV), antinuclear antibodies (ANA) and autoantibodies against various extractable nuclear antigens (ENA) did not reveal evidence for viral originators or autoimmune diseases. This case indicates that in acute viral myositis associated with extreme CK elevation (>400,000 IU/L) AKI might be completely absent. Potential causes for this clinical phenotype, differential diagnosis and management are discussed.© 2021. Springer-Verlag GmbH Austria, part of Springer Nature.

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